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

Circulation ◽  
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

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

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anitha Rajamanickam ◽  
Kaylan Mucci ◽  
Sandeep Basnet ◽  
Ravinder Rao ◽  
Jimmy Yee ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Significance ◽  
Number Of Patients ◽  
Intracranial Bleed ◽  
History Of ◽  
Ischemic Attack

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.

Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ricardo O Escarcega ◽  
Rebecca Torguson ◽  
Marco A Magalhaes ◽  
Nevin C Baker ◽  
Sa’ar Minha ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Term Survival ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
F Carrasco-Chinchilla ◽  
A J Dominguez-Franco ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Abstract Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis. Methods From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old Results The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months. Conclusions TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.

Extended follow up after isolated aortic valve replacement in the elderly

2003 ◽  
Vol 12 (2) ◽  
pp. 103-107 ◽  
Author(s):  
Cara A. Wasywich ◽  
Peter N. Ruygrok ◽  
Teena M. West ◽  
David A. Haydock
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
The Elderly

scholarly journals 401 Conventional Aortic Valves Versus Rapidly Deployed Valves in The Elderly Population. A Comparative Study in A Single Centre Experience

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Moawad ◽  
A McCrorie ◽  
F Aljanadi ◽  
M Jones
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Statistical Significance ◽  
Significant Proportion ◽  
Pacemaker Implantation ◽  
Group Versus ◽  
The Elderly ◽  
Surgical Aortic Valve Replacement ◽  
Increased Risk

Abstract Aim Current recommendations favour TAVI over Surgical Aortic valve replacement (SAVR) for patients aged&gt;75 years. However, in current practice a significant proportion of patients in this group are offered SAVR. Rapidly deployed valves are of increasing popularity among surgeons as they shorten the procedure time, but their benefits are yet to be investigated. Method Patients aged &gt;75 years undergoing Aortic valve replacement with or without any concomitant procedure were included between January 2014 and January 2020 (total: 597). Patients were divided into two groups: Group A (495 patients) conventional Aortic valve and Group2 (102 patients) rapidly deployed valve. Results Preoperative variables including mean age, EuroScore II, and body mass index were of no statistical significance between the two groups. More females and Octogenarians were in the rapidly deployed valve group versus the conventional valve group, respectively. Bypass time and Cross-clamp times were shorter in rapidly deployed group. However, the length of ICU and hospital stay was not significant between the two groups. Early post-operative pacemaker implantation (Conventional 2% Vs RDV 7%) (P &lt; 0.05) differed significantly between groups. At follow up echocardiography, pressure gradients were comparable between groups. Thirty-day mortality and valve-related complications were insignificant. Conclusions RDVs show comparable early and medium-term outcomes and valve hemodynamics. RDVs are associated with shortened operative time and cross-clamp time but may carry an increased risk of need for permanent pacing.

scholarly journals Comparison of Short and Mid-Term Mortality and Morbidity in Patients With Severe Aortic Stenosis (Intermediate/High Risk) Who Underwent Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement

2020 ◽  
Vol 23 (2) ◽  
pp. E212-E220
Author(s):  
Mehmet Ali Yesiltas ◽  
İsmail Haberal ◽  
Yusuf Kuserli ◽  
Ahmet Yildiz ◽  
Ahmet Ozan Koyuncu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Arrhythmias ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Mortality And Morbidity ◽  
Transcatheter Aortic Valve ◽  
Cardiology Department

Treatment protocols for severe aortic valve stenosis include surgical aortic valve replacement (SAVR), balloon valvuloplasty, transcatheter aortic valve replacement (TAVR), and medical  treatment. Because the success rates are getting higher with both SAVR and TAVR, making the right treatment decision is important. This study retrospectively shows the short- (1 month) and mid-term (6 months) mortality and morbidity rate differences between 2 groups of patients, who arrived to our hospital from January 2014 through October 2018. The first group consists of 54 patients who underwent mid-high risk SAVR operations at Istanbul University-Cerrahpasa, Institute of Cardiology, Department of Cardiovascular Surgery. The second group consists of 57 patients who underwent TAVR at the Cardiology Department. Preoperative evaluation showed that the mean age of the SAVR group (71.5 years) was higher than the TAVR group (80 years). Also, the history of previous cardiac valve replacement surgery significantly was higher in the SAVR group than the TAVR group (P = .028). There were no significant differences between the remaining preoperative tests and diagnostic procedures. Of the patients who underwent SAVR, 3.7% experienced postoperative cardiac arrhythmias, while the 17.5% of patients from the TAVR group experienced cardiac arrhythmias after the procedure. This difference between the groups were statistically significant. Mortality rate was 9.3% in the SAVR group and 5.3% in the TAVR group. The mortality rate was not statistically different between the groups. There was no significant difference between the groups in the means of neurological incidents. The TAVR group had more vascular complications (17.9% to none) and pacemaker implantations (21.4% to 1.9%). Minor or major bleeding was the most common reason for admission to the hospital after SAVR. Seven out of 10 patients experienced bleeding. Aortic regurgitation was more common in the TAVR group at the first and sixth month following the procedure. Ratios between the gradient values were higher in the SAVR group (P < .001). Peak gradient values at the sixth month following the procedure were lower than the values of the first month (P < .040). Aortic regurgitation symptoms increased with patients at the mid-term follow-up appointment. To prevent the vascular complications in the TAVR group, preoperative peripheral vascular examination thoroughly should be performed. Considering that bleeding disorders are the main reason the SAVR group arrived to the hospital, INR values should closely be monitored. There seems to be no mortality difference between the groups at the six-month follow up, but studies should continue with more patients and long-term results.

scholarly journals AN EARLY EGYPTIAN EXPERIENCEIN OZAKI TECHNIQUE

2020 ◽  
Vol 8 (11) ◽  
pp. 444-448
Author(s):  
Mohamed A. El-badawy ◽  
◽  
Mohamed R. Abdelbaky ◽  
Mostafa M. Abdalraouf ◽  
Hussein A. Zaher ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Postoperative Bleeding ◽  
Mechanical Valve ◽  
Mortality And Morbidity ◽  
Replacement Surgery ◽  
Significant Difference ◽  
The Mean

Background: The advantage of Ozaki technique for aortic valve replacement surgery over the conventional approach is still debated. This study aimed to evaluate early outcomes after aortic valve replacement using the Ozaki technique Methods: We prospectively included 20 patients who had aortic valve replacement May 2018 to June 2020. Postoperative bleeding, mechanical ventilation, ICU stay and echocardiographic outcomes were observed. Results: The mean age was 39.9±14.8 (20-69) years.13 patient had aortic regurge while 7 had aortic stenosis. Aortic cross-clamp (76.2±8.5 (60-100) and cardiopulmonary bypass times (103.8±15.3 (80-125).One patient (5%) was converted to aortic valve replacement by mechanical valve due to significant aortic regurge. Neither significant gradient nor regurge was found on one month follow-up echography. Freedom from infective endocarditis was found in all patients. No significant difference was found in the ejection fraction pre and post-operative. Conclusion: This novel technique seems to have a promising and favorable outcome with no need for anticoagulation and lesser post-operative complication compared to ordinary aortic valve replacement. This technique is associated with low mortality and morbidity.

scholarly journals Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement

Perfusion ◽  
2021 ◽  
pp. 026765912110458
Author(s):  
Shwe Oo ◽  
Amilah Khan ◽  
Jeremy Chan ◽  
Sanjay Juneja ◽  
Massimo Caputo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Rank Test ◽  
Term Outcome ◽  
Term Survival ◽  
Operative Outcomes ◽  
Significant Difference

Objective: To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR). Methods: A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR ( n = 516) or MIAVR ( n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results: The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male ( n = 57) and female ( n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female ( n = 54) and 53% male ( n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31). Conclusion: Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.

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

2005 ◽  
Vol 13 (2) ◽  
pp. 112-118 ◽  
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.

scholarly journals Transcatheter aortic valve replacement using the iSleeve expandable sheath in small femoral arteries

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001703
Author(s):  
Natalie Glaser ◽  
Crochan J. O'Sullivan ◽  
Nawzad Saleh ◽  
Dinos Verouhis ◽  
Magnus Settergren ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Femoral Artery ◽  
Transcatheter Aortic Valve Replacement ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Femoral Arteries ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

BackgroundSmall femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries.MethodsIn this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5–9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9–5.4).ResultsThere was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter.ConclusionTransfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis.

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