Pre- and Post-Transcatheter Aortic Valve Replacement Serum Brain Natriuretic Peptide Levels and All-Cause Mortality

Background: Risk stratification in patients post-transcatheter aortic valve replacement (TAVR) is limited to and is based on clinical judgment and surgical scoring systems. Serum natriuretic peptides are used for general risk stratification in patients with aortic stenosis, reflecting the increase in their afterload and thereby stressing the need for valve intervention. The objective of this study was to determine the predictive value of pre- and post-procedural serum brain natriuretic peptide (BNP) on 1-year all-cause mortality in patients who underwent TAVR. Methods: In this population-based study, we included 148 TAVR patients treated at the Poriya Medical Center between June 1, 2015, and May 31, 2018. Routine blood samples for serum BNP levels (pg/mL) were taken just before the TAVR and 24 h post-TAVR. Our primary clinical outcome was defined as 1-year all-cause mortality. We used backward regression models and included all variables that had a p value <0.1 in the univariable analysis. A receiver-operating characteristic curve was calculated for the prediction of all-cause mortality by serum BNP levels using the median as the cut-off point. Results: In this study cohort, BNP levels 24 h post-TAVR higher than the cohort median versus lower than the cohort median (387.5 pg/mL; IQR 195–817.6) were the strongest predictor of 1-year mortality (hazard ratio 9; 95% CI 2.72–30.16; p < 0.001). The statistically significant relationship was seen in the unadjusted regression model as well as after the adjustment for clinical variables. Conclusions: Serum BNP levels 24 h post-procedure were found to be a meaningful marker in predicting 1-year all-cause mortality in patients after TAVR procedure.

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HEMODYNAMICS ASSOCIATED WITH PRE-PROCEDURAL ELEVATED B-TYPE NATRIURETIC PEPTIDE IN PATIENTS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)03093-x ◽

2021 ◽

Vol 77 (18) ◽

pp. 1737

Author(s):

Derek Phan ◽

Jesse Goitia ◽

Ming-Sum Lee ◽

Naing Moore ◽

Prakash Mansukhani ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Natriuretic Peptide ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Duration of Antiplatelet Therapy Following Transcatheter Aortic Valve Replacement: Systematic Review and Network Meta‐Analysis

Journal of the American Heart Association ◽

10.1161/jaha.120.019490 ◽

2021 ◽

Author(s):

Toshiki Kuno ◽

Yujiro Yokoyama ◽

Alexandros Briasoulis ◽

Makoto Mori ◽

Masao Iwagami ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Antiplatelet Therapy ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Therapy Group ◽

Meta Analysis ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Life Threatening

Background Although current guidelines recommend dual antiplatelet therapy (DAPT) for 3 to 6 months following transcatheter aortic valve replacement (TAVR), there are no studies directly comparing outcomes of different durations of DAPT following TAVR. Methods and Results PubMed, EMBASE, and Cochrane Database were searched through November 2020 to identify clinical studies that investigated single antiplatelet therapy versus DAPT use following TAVR. Studies using oral anticoagulants and antiplatelet therapy concomitantly were excluded. The DAPT group was subdivided by the duration of DAPT. We extracted the risk ratios (RRs) of major or life‐threatening bleeding, stroke, and all‐cause mortality. Four randomized controlled trials, 2 propensity‐score matched studies, and 1 observational study were identified, yielding a total of 2498 patients who underwent TAVR assigned to the single antiplatelet therapy group (n=1249), 3‐month DAPT group (n=485), or 6‐month DAPT group (n=764). Pooled analyses demonstrated that when compared with the single antiplatelet therapy group, the rates of major or life‐threatening bleeding were significantly higher in the 3‐ and 6‐month DAPT groups (RR [95% CI]=2.13 [1.33–3.40], P =0.016; RR [95% CI]=2.54 [1.49–4.33], P =0.007, respectively) with no difference between the 3‐month DAPT versus 6‐month DAPT groups. The rates of stroke and all‐cause mortality were similar among the 3 groups. Conclusions In this network meta‐analysis of antiplatelet therapy following TAVR, single antiplatelet therapy with aspirin had lower bleeding without increasing stroke or death when compared with either 3‐ or 6‐month DAPT.

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Association of aortic valvular complex calcification burden with procedural and long-term clinical outcomes after transcatheter aortic valve replacement

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab180 ◽

2021 ◽

Author(s):

Euihong Ko ◽

Do-Yoon Kang ◽

Jung-Min Ahn ◽

Tae Oh Kim ◽

Ju Hyeon Kim ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Clinical Outcomes ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

High Tertile ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Composite Outcomes

Abstract Aims This study aimed to assess the impact of valvular/subvalvular calcium burden on procedural and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Methods and results In this prospective observational cohort study, we included patients with AS undergoing TAVR between March 2010 and December 2019. Calcium burden at baseline was quantified using multidetector computed tomography and the patients were classified into tertile groups according to the amount of calcium. Procedural outcomes [paravalvular leakage (PVL) or permanent pacemaker insertion (PPI)] and 12-month clinical outcomes (composite of death, stroke, or rehospitalization, and all-cause mortality) were assessed. A total of 676 patients (age, 79.8 ± 5.4 years) were analysed. The 30-day rates of moderate or severe PVL (P-for-trend = 0.03) and PPI (P-for-trend = 0.002) proportionally increased with the tertile levels of calcium volume. The 12-month rate of primary composite outcomes was 34.2% in low-tertile, 23.9% in middle-tertile, and 25.8% in high-tertile groups (log-rank P = 0.02). After multivariable adjustment, the risk for primary composite outcomes at 12 months was not significantly different between the tertile groups of calcium volume [reference = low-tertile; middle-tertile, hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.54–1.22; P = 0.31; high-tertile, HR 0.93; 95% CI 0.56–1.57; P = 0.80]. A similar pattern was observed for all-cause mortality. Conclusion The rates of PVL and PPI proportionally increased according to the levels of valvular/subvalvular calcium volume, while the adjusted risks for composite outcomes and mortality at 12 months were not significantly different.

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Risk stratification for nonagenarians undergoing transcatheter aortic valve replacement

Journal of Cardiac Surgery ◽

10.1111/jocs.14350 ◽

2019 ◽

Vol 35 (2) ◽

pp. 294-299

Author(s):

Pey‐Jen Yu ◽

Michael Catalano ◽

Robert Palazzo ◽

Hugh Cassiere ◽

Nina Kohn ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Risk Stratification ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve

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Transapical approach versus transcervical approach for transcatheter aortic valve replacement: a retrospective monocentric study

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa202 ◽

2020 ◽

Vol 31 (6) ◽

pp. 781-788 ◽

Cited By ~ 1

Author(s):

Henri Lu ◽

Stephane Fournier ◽

Jegaruban Namasivayam ◽

Christian Roguelov ◽

Enrico Ferrari ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Cox Proportional Hazards Model ◽

Transcatheter Aortic Valve ◽

Number Of Patients ◽

First Choice ◽

All Cause Mortality ◽

Procedure Duration

Abstract OBJECTIVES Transfemoral approach is the standard access-route for transcatheter aortic valve replacement (TAVR). However, alternative approaches are needed in a number of patients and accesses such as transapical (TA) TAVR or transcervical (TC) are used. We aimed to compare clinical and echocardiographic outcomes after TA-TAVR or TC-TAVR. METHODS All patients who underwent TA- and TC-TAVR for severe aortic stenosis in our institution between 2008 and 2020 were retrospectively included. End points included 30-day all-cause mortality, procedural complications (according to the Valve Academic Research Consortium-2 criteria), procedure duration, intensive care unit (ICU) length of stay (LOS) and overall hospital LOS. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as difference in year of intervention. RESULTS TAVR was performed in 176 patients, using a TA approach (n = 127) or a TC approach (n = 49). Baseline clinical and echocardiographic characteristics were comparable between the 2 groups, except age and peripheral artery disease. All-cause 30-day mortality rates were not significantly different (8.5% in the TA group vs 2.3% in the TC group, P = 0.124). TC approach was associated with significantly shorter procedure duration {71.0 [interquartile range (IQR) 52.5–101.0] vs 93 [IQR 80.0–120.0] min, P < 0.001}, shorter ICU LOS [0.0 (IQR 0.0–0.0) vs 1.0 (IQR 1.0–3.0) days, P < 0.001] and shorter hospital LOS [7.0 (IQR 5.0–9.5) vs 14.0 (IQR 10.0–22.0) days, P < 0.001]. CONCLUSIONS The TC approach may be a good first-choice alternative in case of contraindications to transfemoral-TAVR.

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