Abstract 190: Risk Factors and Outcomes of Hyperbilirubinemia Following Transcatheter Aortic Valve Replacement

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Stephanie Jou ◽  
Li Zhang ◽  
Batyrjan Bulibek ◽  
Mohammad El-Hajjar ◽  
Augustin Delago ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Confidence Interval ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hazard Ratio ◽  
P Value ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

Background: It has been established that postoperative hyperbilirubinemia is associated with increased mortality and morbidity after cardiac surgery. However, hyperbilirubinemia after transcatheter aortic valve replacement (TAVR) has not yet been a subject of clinical research. We evaluated the incidence and risk factors of post-TAVR hyperbilirubinemia, and aimed to determine its prognostic significance. Methods: A retrospective observational study was conducted on 241 consecutive TAVR patients between January 2011 and December 2014 in our institution. We excluded 15 patients with documented chronic hepatic or biliary disorders, or prior liver transplant. Hyperbilirubinemia was defined as any value above the upper limit of normal total bilirubin within 1 week of TAVR. Results: Eighty-two patients out of 226 (36.3%) had post-TAVR hyperbilirubinemia. After adjustment for confounders, there was no significant difference in in-hospital mortality (3.7% (3 of 82) vs. 1.4% (2 of 144); p-value = 0.26) and 1-year mortality (7.3% (6 of 82) vs 5.6% (8 of 144); p-value = 0.60) between patients with and without elevated bilirubin following TAVR. However, there was a trend for hyperbilirubinemic patients to have a longer intensive care unit stay (145.3 +/-202.2 hours vs. 113.2 +/-93.4 hours; p-value = 0.14) and hospital stay (14.1 +/-11.2 days vs. 12.1 +/-8.6 days; p-value = 0.16). Multivariable analysis revealed that preoperative hyperbilirubinemia (hazard ratio 62.88, 95% confidence interval 15.80 to 250.32; p-value <0.0001) and preoperative atrial fibrillation (hazard ratio 2.40, 95% confidence interval 1.21 to 4.78; p-value = 0.01) were strongly associated with post-TAVR hyperbilirubinemia. Conclusions: The cause of post-TAVR hyperbilirubinemia may be multifactorial. It is not a rare event and may impact the short-term outcomes. Thus, monitoring bilirubin should be considered an integrated part of TAVR patient care. Optimal management of post-TAVR hyperbilirubinemia remains challenging.

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.

scholarly journals Infective Endocarditis After Surgical and Transcatheter Aortic Valve Replacement: A State of the Art Review

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Sophia L. Alexis ◽  
Aaqib H. Malik ◽  
Isaac George ◽  
Rebecca T. Hahn ◽  
Omar K. Khalique ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve Endocarditis ◽  
Paravalvular Leak ◽  
Surgical Aortic Valve Replacement ◽  
Entry Site ◽  
Transcatheter Aortic Valve ◽  
Significant Difference

Abstract Prosthetic valve endocarditis (PVE) after surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) carries significant morbidity/mortality. Our review aims to compare incidence, predisposing factors, microbiology, diagnosis, management, and outcomes of PVE in surgical aortic valve replacement/TAVR patients. We searched PubMed and Embase to identify published studies from January 1, 2015 to March 13, 2020. Key words were indexed for original reports, clinical studies, and reviews. Reports were evaluated by 2 authors against a priori inclusion/exclusion criteria. Studies were included if they reported incidence and outcomes related to surgical aortic valve replacement/TAVR PVE and excluded if they were published pre‐2015 or included a small population. We followed the Cochrane methodology and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines for all stages of the design and implementation. Study quality was based on the Newcastle‐Ottawa Scale. Thirty‐three studies with 311 to 41 025 patients contained relevant information. The majority found no significant difference in incidence of surgical aortic valve replacement/TAVR PVE (reported as 0.3%–1.2% per patient‐year versus 0.6%–3.4%), but there were key differences in pathogenesis. TAVR has a specific set of infection risks related to entry site, procedure, and device, including nonstandardized protocols for infection control, valve crimping injury, paravalvular leak, neo‐leaflet stress, intact/calcified native leaflets, and intracardiac hardware. With the expansion of TAVR to lower risk and younger patients, a better understanding of pathogenesis, patient presentation, and guideline‐directed treatment is paramount. When operative intervention is necessary, mortality remains high at 20% to 30%. Unique TAVR infection risks present opportunities for PVE prevention, therefore, further investigation is imperative.

scholarly journals Variation in Antithrombotic Therapy and Clinical Outcomes in Patients With Preexisting Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Matthew W. Sherwood ◽  
Aakriti Gupta ◽  
Sreekanth Vemulapalli ◽  
Zhuokai Li ◽  
Jonathan Piccini ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Hazard Ratio ◽  
Risk Of Bleeding ◽  
Significant Variability ◽  
Transcatheter Aortic Valve ◽  
Discharge Medication

Background: Optimal antithrombotic management of patients with preexisting atrial fibrillation undergoing transcatheter aortic valve replacement is challenging given the need to balance the risk of bleeding and thromboembolism. We aimed to examine variation in care and association of antithrombotic therapies with 1-year outcomes of stroke, bleeding, and mortality in patients undergoing transcatheter aortic valve replacement with concomitant atrial fibrillation in the United States. Methods: Patients who underwent transcatheter aortic valve replacement with preexisting atrial fibrillation from November 2011 through September 2015 in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry linked to the Medicare database were examined according to receipt of oral anticoagulants (OACs) or antiplatelet therapies (APTs) or a combination of these (OAC+APT) at discharge. To assess the associations of antithrombotic therapies with 1-year outcomes of stroke, bleeding, and mortality, we utilized inverse probability weighting for antithrombotic therapies and multivariable regression modeling to adjust for patient- and hospital-level variables. Results: In the 11 382 patients included in our study, 5833 (51.2%) were discharged on OAC+APT, 4786 (42.0%) on APT alone, and 763 (6.7%) on OAC alone. There was significant variability in discharge medication patterns, including 42% of patients discharged without OAC therapy. In adjusted analyses, the risk for all-cause mortality and stroke was not significantly different when comparing the 3 different antithrombotic strategies. Risk of bleeding was higher with OAC+APT compared with APT alone (hazard ratio, 1.16 [95% CI, 1.05–1.27]) and similar compared with OAC alone (hazard ratio, 1.17 [95% CI, 0.93–1.47]). Conclusions: There was significant variability in discharge medication patterns across US sites in patients with atrial fibrillation undergoing transcatheter aortic valve replacement, including significant underuse of OAC in this high-risk cohort. The use of OAC+APT (versus OAC alone or APT alone) was not associated with a lower risk of stroke or mortality but was associated with increased risk of bleeding complications at 1 year compared with APT alone.

scholarly journals Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-4
Author(s):  
Masaki Tsuda ◽  
Isamu Mizote ◽  
Takashi Mukai ◽  
Yasushi Sakata
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Transoesophageal Echocardiography ◽  
Additional Risk Factor ◽  
Transfemoral Approach ◽  
Transcatheter Aortic Valve

Abstract Background Aortic root rupture is a severe complication of balloon-expandable transcatheter aortic valve replacement (TAVR). Although previous studies have revealed several risk factors for this complication, predicting this complication is occasionally difficult. Case summary A 78-year-old male patient underwent TAVR via a transfemoral approach using a 29-mm balloon-expandable valve. No recognized risk factors for aortic root rupture existed in pre-procedural multi-detector computed tomography (MDCT) analysis. However, after the valve deployment, sudden haemodynamic collapse occurred. Transoesophageal echocardiography revealed pericardial effusion, which led to an immediate diagnosis of cardiac tamponade following aortic root rupture. Following pericardial drainage via a subxiphoid approach, the haemodynamics were immediately stabilized. After 10 days of close observation, the patient was discharged on Day 39 without additional problems. He was still alive at the 6-month follow-up without sequelae. Discussion Established risk factors for aortic root rupture include &gt;20% area oversizing, bicuspid aortic valve, small annulus (&lt;20 mm), shallow sinus of Valsalva (SOV) compared with the aortic annulus, and massive annular or subannular calcification. Our patient did not have any of the recognized risk factors for aortic root rupture, suggesting the existence of other factors. Pre-procedural MDCT showed a flat calcification orthogonal to the aortic root wall, and post-procedural MDCT revealed that this calcification penetrated the SOV with extravasation. Thus, we suggest that a flat calcification orthogonal to the aortic root wall might be an additional risk factor for aortic root rupture.

P3855Incidence, risk factors and impact of readmission for heart failure after successful transcatheter aortic valve replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Guedeney ◽  
F Huchet ◽  
F Manigold ◽  
S Rouanet ◽  
E Vicaut ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Transcatheter Aortic Valve

Abstract Background Incidence and correlates of readmission for heart failure in all-comers, after successful transcatheter aortic valve replacement (TAVR) remain unclear. Objective We sought to evaluate the incidence, risk factors and clinical impact of readmission for HF after successful TAVR in an unselected patient population. Methods All patients who underwent successful TAVR in two high-volume French tertiary centers from February 2010 to December 2016 were prospectively included and followed-up for one year. Cox multivariate model was used to assess risk factors of readmission for heart failure, evaluated a time-updated covariate and mortality. Results A total of 1139 patients (mean age 82.4±7.7 years, 52.2% male) were included. Readmission for heart failure occurred in 99 (8.7%) patients. Risk factors of readmission for HF were chronic pulmonary disease (adjHR 1.8; 95% CI [1.2–2.8], p=0.008), chronic kidney disease (adjHR 1.7; 95% CI [1.1–2.6], p=0.01), diabetes mellitus (adjHR 1.7; 95% CI [1.1–2.5], p=0.01), prior atrial fibrillation (adjHR 1.6; 95% CI [1.1–2.4], p=0.02) and post-TAVR left ventricular ejection fraction (LVEF) ≤35% (adjHR 2.1 95% CI 1.2–3.7, p=0.009). Readmission for HF was strongly associated with mortality (Figure) along with increased STS score (adjHR 1.07 95% CI 1.03–1.12, p=0.002), prior atrial fibrillation (adjHR 2.13 95% CI 1.53–2.96, p<0.001) and shock during the index hospitalization (adjHR 2.68 95% CI 1.48–4.87, p=0.001). Figure 1 Conclusion Readmission for heart failure occurs in one out of ten patients after successful TAVR and is strong risk factor of mortality. Comorbidities and post-TAVR LVEF≤35% are the main correlates of readmission for heart failure. Acknowledgement/Funding ACTION study group

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