scholarly journals Comparison of Transvalvular Aortic Mean Gradients Obtained by Intraprocedural Echocardiography and Invasive Measurement in Balloon and Self‐Expanding Transcatheter Valves

2021 ◽  
Author(s):  
Amr E. Abbas ◽  
Ramy Mando ◽  
Amer Kadri ◽  
Houman Khalili ◽  
George Hanzel ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Poor Correlation ◽  
Weak Correlation ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Before And After ◽  
Transcatheter Valves ◽  
Predicted Risk ◽  
Low Ejection Fraction ◽  
Invasive Measurement

Background Concerns about discordance between echocardiographic and invasive mean gradients after transcatheter aortic valve replacement (TAVR) with balloon‐expandable valves (BEVs) versus self‐expanding valves (SEVs) exist. Methods and Results In a multicenter study, direct‐invasive and echocardiography‐derived transvalvular mean gradients obtained before and after TAVR were compared as well as post‐TAVR and discharge echocardiographic mean gradients in BEVs versus SEVs in 808 patients. Pre‐TAVR, there was good correlation ( R =0.614; P <0.0001) between direct‐invasive and echocardiography‐derived mean gradients and weak correlation ( R =0.138; P <0.0001) post‐TAVR. Compared with post‐TAVR echocardiographic mean gradients, both valves exhibit lower invasive and higher discharge echocardiographic mean gradients. Despite similar invasive mean gradients, a small BEV exhibits higher post‐TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post‐TAVR and discharge mean gradients. An ejection fraction <50% ( P =0.028) and higher Society of Thoracic Surgeons predicted risk of mortality score ( P =0.007), but not invasive or echocardiographic mean gradient ≥10 mm Hg ( P =0.378 and P =0.341, respectively), nor discharge echocardiographic mean gradient ≥20 mm Hg ( P =0.393), were associated with increased 2‐year mortality. Conclusions Invasively measured and echocardiography‐derived transvalvular mean gradients correlate well in aortic stenosis but weakly post‐TAVR. Post‐TAVR, echocardiography overestimates transvalvular mean gradients compared with invasive measurements, and poor correlation suggests these modalities cannot be used interchangeably. Moreover, echocardiographic mean gradients are higher on discharge than post‐TAVR in all valves. Despite similar invasive mean gradients, a small BEV exhibits higher post‐TAVR and discharge echocardiographic mean gradients than a large BEV, whereas small and large SEVs exhibit similar post‐TAVR and discharge mean gradients. Immediately post‐TAVR, elevated echocardiographic‐derived mean gradients should be assessed with caution and compared with direct‐invasive mean gradients. A low ejection fraction and higher Society of Thoracic Surgeons score, but not elevated mean gradients, are associated with increased 2‐year mortality.

scholarly journals Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Alexander A. Brescia ◽  
G. Michael Deeb ◽  
Stephane Leung Wai Sang ◽  
Daizo Tanaka ◽  
P. Michael Grossman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

scholarly journals Dynamics of processes of left ventricle adaptation in children with aorta coarctation before and after surgical treatment

2018 ◽  
Vol 16 (1) ◽  
pp. 11
Author(s):  
D. S. Prokhorova ◽  
G. P. Nartsissova ◽  
Yu. N. Gorbatykh ◽  
Yu. S. Sinelnikov ◽  
A. V. Gorbatykh
Keyword(s):  
Surgical Treatment ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Coarctation Of Aorta ◽  
Longitudinal Function ◽  
Left Ventricle Remodeling ◽  
Echocardiographic Study ◽  
Before And After ◽  
Eccentric Hypertrophy ◽  
Low Ejection Fraction

The results of echocardiographic study of 87 children with coarctation of aorta before and after surgical treatment are presented. All children were broken down in two groups: patients with a low ejection fraction and those with a normal one. While determining the type of left ventricle remodeling, eccentric hypertrophy was revealed in 46% of patients in the first group, mainly in children with a preductal variant of aorta coarctation. It was found out that the echocardiographic characteristics of the first group patients, who underwent surgery at the age of more than 6 months, were restored slowly. In general, LV functional characteristics were restored faster than the geometrical ones. When studying a longitudinal function of the left ventricle, an increase in the index of myocardial contractility and a decrease in the myocardial rates in 100 % of cases were revealed.

Evaluation of the Performance of ACS NSQIP Surgical Risk Calculator in Emergency General Surgery Patients

2020 ◽  
Vol 86 (2) ◽  
pp. 83-89
Author(s):  
Andrea M. Long ◽  
Amy N. Hildreth ◽  
Patrick T. Davis ◽  
Rebecca Ur ◽  
Ashley T. Badger ◽  
...  
Keyword(s):  
General Surgery ◽  
Outcome Expectations ◽  
Poor Correlation ◽  
Risk Calculator ◽  
Inclusion Criteria ◽  
Emergency General Surgery ◽  
Surgical Risk ◽  
Acs Nsqip ◽  
Risk Of Mortality ◽  
Predicted Risk

The ACS NSQIP Surgical Risk Calculator is designed to estimate the chance of an unfavorable outcome after surgery. Our goal was to evaluate the accuracy of the calculator in our emergency general surgery population. Surgical outcomes were compared to predicted risk. The risk was calculated with surgeon adjustment scores (SASs) of 1 (no adjustment), 2 (risk somewhat higher), and 3 (risk significantly higher than estimate). Two hundred and twenty-seven patients met the inclusion criteria. An SAS of 1 or 2 accurately predicted risk of mortality (5.7% and 8.5% predicted versus 7.9% actual), whereas a risk adjustment of 3 indicated significant overestimation of mortality rate (14.8% predicted). There was good overall prediction performance for most variables with no clear preference for SAS 1, 2, or 3. Poor correlation was seen with SSI, urinary tract infection, and length of stay variables. The ACS NSQIP Surgical Risk Calculator yields valid predictions in the emergency general surgery population, and the data support its use to inform conversations about outcome expectations.

scholarly journals Comorbidity Burden and Adverse Outcomes After Transcatheter Aortic Valve Replacement

2021 ◽  
Author(s):  
Daniel R. Feldman ◽  
Mikhail D. Romashko ◽  
Benjamin Koethe ◽  
Sonika Patel ◽  
Hassan Rastegar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Odds Ratio ◽  
Chronic Conditions ◽  
Transcatheter Aortic Valve Replacement ◽  
Disease Burden ◽  
Comorbid Conditions ◽  
Comorbid Disease ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Predicted Risk

Background Transcatheter aortic valve replacement (TAVR) has become the preferred treatment for symptomatic patients with aortic stenosis and elevated procedural risk. Many deaths following TAVR are because of noncardiac causes and comorbid disease burden may be a major determinant of postprocedure outcomes. The prevalence of comorbid conditions and associations with outcomes after TAVR has not been studied. Methods and Results This was a retrospective single‐center study of patients treated with TAVR from January 2015 to October 2018. The association between 21 chronic conditions and short‐ and medium‐term outcomes was assessed. A total of 341 patients underwent TAVR and had 1‐year follow‐up. The mean age was 81.4 (SD 8.0) years with a mean Society of Thoracic Surgeons predicted risk of mortality score of 6.7% (SD 4.8). Two hundred twenty (65%) patients had ≥4 chronic conditions present at the time of TAVR. There was modest correlation between Society of Thoracic Surgeons predicted risk of mortality and comorbid disease burden ( r =0.32, P <0.001). After adjusting for Society of Thoracic Surgeons predicted risk of mortality, age, and vascular access, each additional comorbid condition was associated with increased rates of 30‐day rehospitalizations (odds ratio, 1.21; 95% CI, 1.02–1.44), a composite of 30‐day rehospitalization and 30‐day mortality (odds ratio, 1.20; 95% CI, 1.02–1.42), and 1‐year mortality (odds ratio, 1.29; 95% CI, 1.05–1.59). Conclusions Comorbid disease burden is associated with worse clinical outcomes in high‐risk patients treated with TAVR. The risks associated with comorbid disease burden are not adequately captured by standard risk assessment. A systematic assessment of comorbid conditions may improve risk stratification efforts.

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