Abstract 18678: Transcutaneous Aortic Valve Replacement -Is Anticoagulation Protective?

INTRODUCTION: Stroke continues to be the most dreaded and quality of life limiting complication of transcutaneous aortic valve replacement [TAVR]. We sought to describe the effects of Anticoagulation[AC] on post TAVR rates of stroke/transient ischemic attack[TIA] and death. METHODS: 196 patients [116 self expanding and 80 balloon expandable] underwent TAVR from December 2010 to August 2013 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients[TAVR prior to September 2012]. Of these, 59 patients were discharged on AC [55 on Coumadin, 4 on Dabigatran] and 137 patients without AC [NO-AC] RESULTS: Atrial fibrillation/flutter[AF] incidence was higher with patients on AC vs NO-AC [ 73% vs 26% ,p <0.001] . There was no difference in diabetes, hypertension, hyperlipidemia, chronic kidney disease, prior MI or stroke, history of thromboembolism, prior gastrointestinal bleed , anemia or cirrhosis. Strokes/TIA after discharge on AC was seen in only 1 patient [subtherapeutic INR of 1.5] and 1 patient had an intracranial bleed on dabigatran vs 5 NO-AC patients [1.7% vs 3.7%, p=0.670].Mortality at I year [13.5 % AC vs 20.4% NO-AC p= 0.3167] - Figure 1. Statistical significance in primary outcomes was not met due to small number of patients CONCLUSION: AC patients showed a trend towards improved survival and stroke rates. This difference can be hypothesized by the reduction in thromboemboli formation at the level of the valve struts. Further studies randomizing TAVR patients to AC and NOAC is needed to see if this observed difference translates to reduction in mortality and strokes.

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Abstract 18908: Transcutaneous Aortic Valve Replacement - 30 Day and 1 Year Outcomes Using Conscious Sedation in Patients Stratified by STS Risk Score

Circulation ◽

10.1161/circ.130.suppl_2.18908 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Anitha Rajamanickam ◽

Sandeep Basnet ◽

Kaylan Mucci ◽

Ravinder Rao ◽

Jimmy Yee ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Conscious Sedation ◽

Statistical Significance ◽

Vascular Complications ◽

The Elderly ◽

Number Of Patients ◽

Significant Difference

Introduction: Transcutaneous Aortic Valve Replacement [TAVR] is usually performed under general anesthesia [GA]. We sought to examine the feasibility and safety of monitored conscious sedation [CS] as opposed to GA . METHODS: 196 patients [116 self expanding and 80 balloons expandable] underwent TAVR from December 2010 to August 2012 at our institution. 1 month follow up was completed on all patients and 1 year follow up was available on 105 patients. 39 patients [20%] underwent CS. Only one patient crossed over from CS to GA. We divided the patients into 3 groups [STS <8, STS of 8 to <12, STS ≥ 12 with the primary endpoints of all-cause mortality at 1 month and 1 year [See Table 1] RESULTS: Though the study did not meet statistical significance due to low number of patients, there was a trend towards improved mortality with CS. Also, there was no statically significant difference with regards to procedural complications including periprocedural MI, major bleeding, emergency CABG or major vascular complications. All 5 patients with periprocedural stroke had GA. The CS patients had a shorter length of stay [5 +2.87 days] as compared to GA patients [8 days+7.86 days] CONCLUSION: Use of CS suggested an improved mortality trend in higher risk patients [STS≥ 12]. This is of great importance as complications of GA, most importantly respiratory complications, are higher in the elderly TAVR patients and these can be avoided with CS . Also CS enables us to monitor neurological status during the procedure which is of vital importance given the high rates of stroke with TAVR

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Trans-Iliac Aortic Valve Replacement: Feasibility, Safety, and Medium-Term Follow-up

Open Journal of Cardiovascular Surgery ◽

10.1177/1179065219853582 ◽

2019 ◽

Vol 11 ◽

pp. 117906521985358

Author(s):

Marco Gennari ◽

Piero Trabattoni ◽

Mauro Pepi ◽

Gianluca Polvani ◽

Luca Salvi ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Major Complication ◽

Medium Term ◽

Transcatheter Aortic Valve ◽

Low Profile ◽

Ischemic Attack

Background: Transcatheter aortic valve replacement (TAVR) is nowadays generally accepted as the treatment of choice for high- to intermediate-risk patients with severe aortic stenosis not suitable for the standard surgical replacement. Many vascular accesses have been described for the valve delivery, comprising the common iliac artery as the arterial site of access. Methods: From September 2008 to June 2014, 440 patients underwent TAVR at our institution. We report a series of 12 patients that have undergone TAVR via a trans-iliac (TI) retroperitoneal surgical approach and also discuss its feasibility, security, and medium-term follow-up. Results: The 30-day survival rate was 92%. Only 1 local vascular access major complication occurred requiring an iliac-femoral bypass grafting with a vascular graft. Two patients experienced transient neurological ischemic attack. At 3-year follow-up, all the 11 patients were alive and well and the echocardiographic evaluation revealed good function of the prosthesis. Conclusions: The TI route seems to be feasible with a low profile of local complications. It may be a reasonable access alternative to the femoral artery and to the trans-apical approach. A broader, prospective study is advisable to gain general consensus on this approach.

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Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center

Journal of Clinical Medicine ◽

10.3390/jcm10225408 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5408

Author(s):

Szymon Jonik ◽

Michał Marchel ◽

Ewa Pędzich-Placha ◽

Zenon Huczek ◽

Janusz Kochman ◽

...

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Heart Team ◽

Secondary Endpoints

Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median follow-up of 866 days of patients with severe AS qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and transcather aortic valve replacement (TAVR) or OMT and surgical aortic valve replacement (SAVR) were evaluated. As the primary endpoint composite of all-cause mortality, non-fatal disabling strokes and non-fatal rehospitalizations for AS were considered, while other clinical outcomes were determined as secondary endpoints. Results: From 2016 to 2019, 176 HT meetings were held, and a total of 482 participants with severe AS and completely implemented HT decisions (OMT, TAVR and SAVR for 79, 318 and 85, respectively) were included in the final analysis. SAVR and TAVR were found to be superior to OMT for primary and all secondary endpoints (p < 0.05). Comparing interventional strategies only, TAVR was associated with reduced risk of acute kidney injury, new onset of atrial fibrillation and major bleeding, while the superiority of SAVR for major vascular complications and need for permanent pacemaker implantation was observed (p < 0.05). The quality of life assessed at the end of follow-up was significantly better for patients who underwent TAVR or SAVR than in OMT-group (p < 0.05). Conclusions: We demonstrated that after careful implementation of HT decisions interventional strategies compared to OMT only provide superior outcomes and quality of life for patients with AS.

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Quality of life after aortic valve replacement with biological prostheses in elderly patients

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2017-3-40-47 ◽

2017 ◽

Vol 21 (3) ◽

pp. 40 ◽

Cited By ~ 1

Author(s):

D. P. Demidov ◽

D. A. Astaspov ◽

A. V. Bogachev-Prokophiev ◽

S. I. Zheleznev

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

Conflict Of Interest ◽

Group I ◽

Biological Prostheses

Aim. The paper aims to assess the quality of life of patients subjected to aortic valve replacement with a stented/stentless biological prosthesis. Methods. The research was done at the Acquired Heart Disease Department of Meshalkin National Medical Research Center. The inclusion criteria were patient age older than 65 years and severe stenosis of the aortic valve. 114 patients were randomized 1:1 in two groups: group I patients received stentless biological prostheses, while group II patients — stented xenopericardial ones. All patients underwent aortic valve replacement under normothermic cardiopulmonary bypass. Mean follow-up was 3.9 [2.77; 4.55] years, mean age 71.5±4 (65–84) years, mean left ventricle ejection fraction 65.5 (40–86) % and mean preoperative Log.Euroscore 5.4±1.3 (1.4–12.4). The quality of life was assessed by using a standard questionnaire SF-36. Results. Peak transprosthetic gradients at 1-year follow-up amounted to 16.22±4.34 and 24.66±4.74 mm Hg for group I and group II respectively. The 5-year survival rate was 90 [81; 99] % and 96 [90; 100] % for the two groups respectively and did not differ statistically (log rank test, p = 0.226). A statistically significant improvement of quality of life among patients in both groups was observed at 1-year follow-up, as compared to the preoperative values, however, marked intergroup differences in any of the parameters were not recorded. Conclusion. The quality of life after aortic valve replacement with stented and stentless biological prostheses in elderly patients confirms clinical and functional efficiency of both methods, does not show sound advantages of any of them and improves both the physical component of health and subjective emotional level.Received 25 July 2017. Revised 18 August 2017. Accepted 28 August 2017.Funding: The study was carried out with the support of a grant of the President of the Russian Federation (МД–6967.2016.7) created to provide government assistance to the leading research centers in Russian Federation.Conflict of interest: The authors declare no conflict of interest.

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Outcomes in asymptomatic, severe aortic stenosis

PLoS ONE ◽

10.1371/journal.pone.0249610 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249610

Author(s):

Anette Borger Kvaslerud ◽

Kenan Santic ◽

Amjad Iqbal Hussain ◽

Andreas Auensen ◽

Arnt Fiane ◽

...

Keyword(s):

Coronary Artery Disease ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Asymptomatic Patients ◽

History Of ◽

Artery Disease

Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.

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Stentless vs. Stented Aortic Valve Replacement: Left Ventricular Mass Regression

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300204 ◽

2005 ◽

Vol 13 (2) ◽

pp. 112-118 ◽

Cited By ~ 8

Author(s):

Muhammed Tamim ◽

Thierry Bové ◽

Yves Van Belleghem ◽

Katrien François ◽

Yves Taeymans ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Valve Replacement ◽

Left Ventricular Mass Index ◽

Statistical Significance ◽

Left Ventricular ◽

Ventricular Mass Index ◽

Ventricular Mass

The aim of this retrospective study was to evaluate the time-related regression of left ventricular hypertrophy after stentless vs. stented aortic valve replacement. From January 1992 to December 2002, 145 patients had a Toronto stentless porcine valve and 106 had a stented Carpentier-Edwards aortic valve replacement. Over a 10-year follow-up, survival was superior in the Toronto group vs. the Carpentier-Edwards group (84% vs. 74% at 4 years; 78% vs. 68% at 6 years; p < 0.001). A significant and constant reduction of peak and mean transvalvular gradients after valve replacement resulted in substantial regression of left ventricular mass index in both groups, which did not reach statistical significance. However, this phenomenon stopped at 3 years, and left ventricular mass index increased slowly after 5 years. Stentless and stented bioprostheses both showed good early and late clinical and hemodynamic outcomes, with the advantage of better midterm survival for stentless xenografts.

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3540 Mid term outcome and quality of life for patients >80 years after aortic valve replacement for aortic stenosis

European Heart Journal ◽

10.1016/s0195-668x(03)96146-x ◽

2003 ◽

Vol 24 (5) ◽

pp. 689

Author(s):

J MAILLEL

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Term Outcome

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Evaluation of Left Ventricular Functions after Aortic Valve Replacement in a Specific Young Male Patient Population with Pure Aortic Insufficiency or Aortic Stenosis: 5-Years Follow-up

The Heart Surgery Forum ◽

10.1532/hsf98.20061142 ◽

2007 ◽

Vol 10 (1) ◽

pp. E57-E63 ◽

Cited By ~ 1

Author(s):

Cengiz Bolcal ◽

Suat Doganci ◽

Oben Baysan ◽

Vedat Yildirim ◽

Murat Sargin ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Male Patient ◽

Patient Population ◽

Young Male ◽

Aortic Insufficiency ◽

Left Ventricular

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Minimally Invasive Transaortic Repair of the Mitral Valve

The Heart Surgery Forum ◽

10.1532/hsf98.20101133 ◽

2011 ◽

Vol 14 (4) ◽

pp. 232 ◽

Cited By ~ 2

Author(s):

Orlando Santana ◽

Joseph Lamelas

Keyword(s):

Mitral Valve ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Valve Replacement ◽

Minimally Invasive ◽

Valve Replacement ◽

Operative Mortality ◽

The Mean ◽

Transaortic Approach

Objective: We retrospectively evaluated the results of an edge-to-edge repair (Alfieri stitch) of the mitral valve performed via a transaortic approach in patients who were undergoing minimally invasive aortic valve replacement.Methods: From January 2010 to September 2010, 6 patients underwent minimally invasive edge-to-edge repair of the mitral valve via a transaortic approach with concomitant aortic valve replacement. The patients were considered to be candidates for this procedure if they were deemed by the surgeon to be high-risk for a double valve procedure and if on preoperative transesophageal echocardiogram the mitral regurgitation jet originated from the middle portion (A2/P2 segments) of the mitral valve.Results: There was no operative mortality. Mean cardiopulmonary bypass time was 137 minutes, and mean cross-clamp time was 111 minutes. There was a significant improvement in the mean mitral regurgitation grade, with a mean of 3.8 preoperatively and 0.8 postoperatively. The ejection fraction remained stable, with mean preoperative and postoperative ejection fractions of 43.3% and 47.5%, respectively. Follow-up transthoracic echocardiograms obtained at a mean of 33 days postoperatively (range, 8-108 days) showed no significant worsening of mitral regurgitation.Conclusion: Transaortic repair of the mitral valve is feasible in patients undergoing minimally invasive aortic valve replacement.

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