Abstract 19134: Elevated Troponin T is Associated with Adverse Outcomes After Aortic Valve Replacement

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ashwat Dhillon ◽  
Kanhaiya Poddar ◽  
Murat Tuzcu ◽  
Eric Roselli ◽  
Lars Svensson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Troponin T ◽  
Coronary Revascularization ◽  
Care Center ◽  
Tertiary Care ◽  
Adverse Outcomes ◽  
Post Procedure

Background: Data regarding association of elevated cardiac enzymes and adverse outcomes in patients who undergo aortic valve replacement (AVR) has been inconclusive. Role of coronary revascularization prior to AVR remains uncertain. We sought to understand prognostic implication of post procedure troponin T (TnT) elevation in patients undergoing AVR. Hypothesis: We hypothesized that patients with significantly elevated TnT after AVR will have worse outcomes representing important coronary circulation which is not revascularized. Methods: We retrospectively studied 4648 consecutive patients who underwent AVR at a single tertiary care center between January 2007 and December 2013. These were divided into surgical AVR (SAVR) and transcatheter AVR (TAVR). Median post procedure peak TnT was identified in the SAVR and TAVR groups. Patients were divided into quartiles based on median TnT level. Results: Of 4648 patients who underwent AVR, 4200 (66% male) were SAVR and 448 (59% male) were TAVR. Median post procedure peak TnT values in the TAVR and SAVR group were 0.19 [0.08-0.39] & 0.36 [0.22-0.64] respectively (p<0.001). 6 month mortality was 1.5% (65/4200) in SAVR cases and 2.7% (12/448) in TAVR cases (p=0.08). In patients with TnT less than 50 th percentile, 6 month mortality was 0.7% & 1.8% after SAVR & TAVR respectively (p=0.1). In patients with TnT higher than 50 th percentile, 6 month mortality was 2.4% & 3.6% after SAVR & TAVR respectively (p=0.26). In the SAVR group, mortality was 0.7% in patients with TnT levels less than 50 th percentile & 2.4% in patients with TnT higher than 50 th percentile (p<0.001). See Figure. Conclusion: Peak troponin T was significantly higher after SAVR as compared to TAVR. Higher post procedure peak TnT is associated with increased 6 month mortality. These results are highly significant in the SAVR group. The mechanism and significance of these findings requires further studies.

Management of large bore access complications in the era of trans-catheter aortic valve replacement

Vascular ◽  
2020 ◽  
pp. 170853812096946
Author(s):  
Michael H Parker ◽  
Dipankar Mukherjee ◽  
Liam Ryan
Keyword(s):  
Aortic Valve ◽  
Length Of Stay ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Care Center ◽  
Tertiary Care ◽  
Vascular Complications ◽  
Femoral Access ◽  
Arterial Complications ◽  
Valvular Stenosis

Objectives Trans-catheter aortic valve replacement is a commonplace procedure for patients with aortic valvular stenosis who are at a high risk for surgery, evidenced by the 34,892 trans-catheter aortic valve replacements performed in 2016. Trans-catheter aortic valve replacement’s rate of major vascular complications with second-generation closure devices is 4.5% according to a meta-analysis of 10,822 patients. To manage those complications, percutaneous approaches to arterial repairs show shorter length of stay, higher rate of direct to home discharge and equivalent outcomes at long-term follow-up. This study’s goal is to show that one center’s vascular access strategy can decrease open repairs and improve patient outcomes. Methods Our team began accessing the mid-common femoral artery at least 1–2 cm proximal to the takeoff of the profunda femoris. This allowed an endovascular stent to be deployed if necessary via contralateral femoral access. We performed a completion angiogram following every trans-catheter aortic valve replacement to ensure no arterial complications. We conducted a retrospective review of a prospectively maintained database for all trans-catheter aortic valve replacement cases at a tertiary care center from 1 January 2016 to 30 June 2018. Results A total of 699 trans-catheter aortic valve replacement procedures were performed with 25/31 (80.6%) cases met inclusion criteria. An increase was noted in the number of stent procedures versus cutdown procedures over time ( P < 0.001). A decrease was noted in the number of vascular surgery team activations following trans-catheter aortic valve replacement ( P = 0.004). A non-significant trend was noted toward a shorter median length of stay for the stent group ( P = 0.149). There was no increase in 30-day mortality rate (0.0% for both groups) or 30-day readmissions (4/15 (26.7%) for stents vs. 2/10 (20.0%) for open repairs; P > 0.999). Conclusions This strategy is safe and feasible to implement and reduces the number of open repairs following trans-catheter aortic valve replacement, activation of surgical resources, and possibly the length of stay.

scholarly journals Transcatheter Aortic Valve Replacement: The Experience of One Brazilian Health Care Center

2018 ◽  
Author(s):  
Fabiula Schwartz Azevedo ◽  
Marcelo Goulart Correa ◽  
Débora Holanda Gonçalves Paula ◽  
Alex dos Santos Felix ◽  
Luciano Herman Juaçaba Belém ◽  
...  
Keyword(s):  
Health Care ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Care Center ◽  
Health Care Center ◽  
Transcatheter Aortic Valve

Abstract 355: Relationship between Female Gender and Mortality after Isolated Aortic Valve Replacement

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Xiumei Sun ◽  
Jennifer Ellis ◽  
Louis Kanda ◽  
Robert Lowery ◽  
Steven W Boyce ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Artery Bypass Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Female Gender ◽  
Operative Outcomes ◽  
Study Population

Background: Previous studies have shown that female gender is an independent predictor of increased operative mortality after coronary artery bypass surgery. It remains inconsistent whether female gender is associated with increased mortality after aortic valve replacement (AVR). The purpose of this study is to investigate the role of female gender inoperative mortality after AVR. Methods: The study population included isolated AVR performed between January 2003 and December 2012 at a single Instituation. Results: During this period, 1,262 patients underwent isolated AVR. The major preoperative characteristics and operative outcomes are detailed in the following table. R>Conclusions: In this study, female patients had increased operative mortality after isolated AVR.

scholarly journals Meta-analysis of right ventricular function in patients with aortic stenosis after transfemoral aortic valve replacement or surgical aortic valve replacement

2020 ◽  
Vol 11 ◽  
pp. 204062232093377
Author(s):  
Yunshan Cao ◽  
Vikas Singh ◽  
Aqian Wang ◽  
Liyan Zhang ◽  
Tingting He ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Right Ventricular Function ◽  
Meta Analysis ◽  
Surgical Aortic Valve Replacement ◽  
Post Procedure

Background: Right ventricular function (RVF) is an independent predictor of prognosis for patients undergoing aortic valve replacement: transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). The effect of transfemoral aortic valve replacement (TF-TAVR) on RVF is uncertain. We aimed to perform a meta-analysis of the effect of TF-TAVR on RVF in patients with aortic stenosis (AS) and compare the effect of TF-TAVR with SAVR. Methods: We searched relevant studies from PubMed, Embase, Cochrane Library databases, and Web of Science. Furthermore, two reviewers (Wang AQ and Cao YS) extracted all relevant data, which were then double checked by another two reviewers (Zhang M and Qi GM). We used the forest plot to present results. Tricuspid annular plane systolic excursion (TAPSE) was the primary outcome. Results: This meta-analysis included 11 studies. There were 353 patients who underwent TF-TAVR, and 358 patients who were subjected to SAVR. There was no significant difference in TAPSE at 1 week and 6 months as well as right ventricular ejection fraction (RVEF) at <2 weeks and 6 months after TF-TAVR. For the SAVR group, TAPSE at 1 week and 3 months as well as fractional area change (FAC) at 3 months post procedure were significantly aggravated, while RVEF did not change significantly. Moreover, TAPSE post-TF-TAVR was significantly improved as compared with post-SAVR. The △TAPSE, the difference between TAPSE post-procedure and TAPSE prior to procedure, was also significantly better in the TF-TAVR group than in the SAVR group. Conclusion: RVF was maintained post TF-TAVR. For SAVR, discrepancy in the measured parameters exists, as reduced TAPSE indicates compromised longitudinal RVF, while insignificant changes in RVEF implicate maintained RVF post procedure. Collectively, our study suggests that the baseline RV dysfunction and the effect of TF-TAVR versus SAVR on longitudinal RVF may influence the selection of aortic valve intervention.

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