Abstract 16974: Gender Differences in Patients Undergoing Transcatheter Aortic Valve Replacement: a Single Center Experience

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Josephine L Warren ◽  
Usman Baber ◽  
Jennifer Yu ◽  
Melissa Aquino ◽  
Arjun Bhat ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Mortality Rates ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Mount Sinai

Background: Current data suggest that women experience different outcomes to men following transcatheter aortic valve replacement (TAVR). We reviewed the Mount Sinai valve database to compare men and women undergoing TAVR according to procedural characteristics and outcomes. Methods: 124 patients underwent TAVR at Mount Sinai from May 2012-2014. All patients received Edwards Sapien valves. Follow-up was conducted at 30-days. Results: Women accounted for 61% (n=76) of the TAVR cohort. The mean age of women was 80.7, and 82.2 for men (p=0.30). Men were more likely to have undergone previous cardiac bypass surgery and were more likely to be on dialysis and have a pacemaker or intra-cardiac defibrillator in-situ (27.1% vs. 7.9%, p=0.004). Women had lower baseline hemoglobin. These disparities did not translate to differences in STS Risk Score or EuroScore. In women, the aortic annulus (21.2mm vs. 23.4mm, p<0.0001), left atrial (24.6mm vs. 27.2mm, p = 0.02) and left ventricular (3.09mm vs. 4.11mm, p<0.001) areas were smaller, as was the ilio-femoral artery diameter (7.4mm vs. 8.03mm, p=0.02). In contrast, men had a lower left ventricular ejection fraction (49.9% vs. 57.6%, p=0.004) and mean aortic valve gradient (43.5mmHg vs. 48.8mmHg, p=0.004). Procedural length did not differ between genders, nor did the method of approach. Women were less likely to experience conduction complications requiring pacemaker insertion both intra-procedurally (2.6% vs. 12.5%, p=0.03) and 30-days post-discharge (2.7% vs. 13.2%, p = 0.03). Women were more likely to receive in-hospital transfusion (51.3% vs. 18.8%, p=0.0003), but mortality rates did not differ between genders (7.0% vs. 6.7%, p=0.5). Conclusion: Despite discrepancies in some important pre-procedural parameters, as well as rates of post-procedural conduction abnormalities and in-hospital transfusion, these did not translate into differences in mortality rates between genders in patients undergoing TAVR.

P3699Circulating pro-apoptotic microRNA-122 correlates with left ventricular function (LVEF) improvement after transcatheter aortic valve replacement and influence cardiomyocyte function via microvesicle

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X Xu ◽  
R Hosen ◽  
P Goody ◽  
S Niepmann ◽  
J Sinning ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve

Abstract Background Transcatheter aortic valve replacement (TAVR) is an established treatment option for high and intermediate risk patients with severe symptomatic aortic stenosis (AS). Whereas the majority of patients develop a left ventricular ejection fraction (LVEF) improvement after TAVR in response to TAVR-associated afterload reduction, around 50% of patients with reduced LVEF fail to develop LVEF improvement after TAVR. MicroRNAs (miRs) are novel biomarkers and effectors of myocardial (dys)function. We aimed to explore whether circulating miRs are differently regulated in response to TAVR in patients with or without postprocedural LV-function improvement. Methods and results 96 patients who underwent TAVR were screened for inclusion into the study. Patients with impaired LVEF (<45%) were divided into three groups according to post-procedural LVEF development assessed 6 months after TAVR by transthoracic echocardiography: No LVEF improvement, LVEF-improvement of 0–15% and >15%. Plasma samples were obtained at 3 different time points: On the day before TAVR-procedure and at days 1 and 7 post-TAVR. Taqman miR array was performed in patients without LVEF improvement group and >15% LVEF improvement. The results showed that miR-122, miR-26a, miR-192, miR-483-5p, miR-720, miR-885-5p and miR-1274 were differently expressed when compared between day 1 and day 7. Based on literature, we also quantified four miRs related to LV function and fibrosis in our collective (miR-21, miR-145, miR-199, miR-30b). We validated these 14 circulating miRs levels and found that miR-122 level significantly increased at day 7 after TAVR in the no LVEF-improvement group. The increase of miR-122 negatively correlated with LVEF improvement at both day 7 (r=−0.237 and p=0.031) and 3 months (r=−0.323 and p=0.02) after TAVR. Within the 2-year follow-up, patients with lower level of miR-122 displayed a significantly reduced cardiovascular mortality (p=0.049). Next, vesicle degradation experiment and ultracentrifugation showed that miR-122 were mainly incorporated in microvesicles (MVs). In vitro, H202 increased miR-122 level in endothelial cells and endothelial-derived MV. Gain and Loss function experiments indicated elevated miR-122 level impaired migration and proliferation on HUVECs. Cardiomyocytes incubated with MVsmiR122-upregulated showed higher miR-122 expression than exosome miR122-upregulated or vesicle-free supernatant. Confocal microscopy confirmed the fluroscence-labeled EVs were absorbed by cardiomyocyte. Absorbed MVsmiR122-upregulated induced apoptosis of recipient cardiomyocytes. Conclusion Changes of circulating pro-apoptotic miR-122 levels significantly correlate with LVEF improvement after TAVR in low LVEF patients and might be suitable to predict the long term prognosis after TAVR in this set of patients. Microvesicles can mediate the transfer of miR-122 from endothelial cells to cardiomyocytes and further influence cardiomyocyte function.

Predictors of Thrombocytopenia after Self-Expandable Transcatheter Aortic Valve Replacement: A Single-Center Experience from China

Cardiology ◽  
2018 ◽  
Vol 139 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Qifeng Zhu ◽  
Xianbao Liu ◽  
Wei He ◽  
Yuxin He ◽  
Mengyao Tang ◽  
...  
Keyword(s):  
Platelet Count ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Clinically Significant

Objectives: The importance of thrombocytopenia (TP) has been discussed previously. However, data are still limited, especially on predictors of TP. We sought to investigate predictors of TP after transcatheter aortic valve replacement (TAVR), in particular, clinically significant TP. Methods: We reviewed a total of 123 consecutive patients undergoing TAVR in our medical center. They were stratified into 3 groups according to the nadir platelet count post-TAVR: no/mild TP, moderate TP, and severe TP. Clinically significant TP, also known as major TP, was defined as moderate-to-severe TP (a nadir platelet count <100 × 109/L and a >50% decrease in platelet count). Results: Baseline platelet, baseline hemoglobin, general anesthesia (GA), valve malpositioning and post-TAVR left ventricular ejection fraction were found to be predictors of post-TAVR nadir platelet count. Major TP was associated with a higher risk of major bleeding (OR 3.524, 95% CI 1.546-8.031) and 1-month mortality (OR 11.226, 95% CI 1.208-104.328). Age (OR 1.110, 95% CI 1.014-1.215) and GA (OR 6.494, 95% CI 2.058-20.408) were predictors of major TP. Conclusion: Post-TAVR nadir platelet count can be predicted based on baseline and procedural data. Old age and GA contribute to clinically significant TP.

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