scholarly journals Patient-prosthesis mismatch: surgical aortic valve replacement versus transcatheter aortic valve replacement in high risk patients with aortic stenosis

2016 ◽  
Vol 8 (10) ◽  
pp. E1441-E1443 ◽  
Author(s):  
Ravi K. Ghanta ◽  
Irving L. Kron
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Patient Prosthesis Mismatch ◽  
Risk Patients

scholarly journals Comparison of in-hospital outcomes and readmissions for valve-in-valve transcatheter aortic valve replacement vs. reoperative surgical aortic valve replacement: a contemporary assessment of real-world outcomes

2020 ◽  
Vol 41 (29) ◽  
pp. 2747-2755 ◽  
Author(s):  
Sameer A Hirji ◽  
Edward D Percy ◽  
Cheryl K Zogg ◽  
Alexandra Malarczyk ◽  
Morgan T Harloff ◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Aortic Valves ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Valve In Valve

Abstract Aims We sought to perform a head-to-head comparison of contemporary 30-day outcomes and readmissions between valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) patients and a matched cohort of high-risk reoperative surgical aortic valve replacement (re-SAVR) patients using a large, multicentre, national database. Methods and results We utilized the nationally weighted 2012–16 National Readmission Database claims to identify all US adult patients with degenerated bioprosthetic aortic valves who underwent either VIV-TAVR (n = 3443) or isolated re-SAVR (n = 3372). Thirty-day outcomes were compared using multivariate analysis and propensity score matching (1:1). Unadjusted, VIV-TAVR patients had significantly lower 30-day mortality (2.7% vs. 5.0%), 30-day morbidity (66.4% vs. 79%), and rates of major bleeding (35.8% vs. 50%). On multivariable analysis, re-SAVR was a significant risk factor for both 30-day mortality [adjusted odds ratio (aOR) of VIV-SAVR (vs. re-SAVR) 0.48, 95% confidence interval (CI) 0.28–0.81] and 30-day morbidity [aOR for VIV-TAVR (vs. re-SAVR) 0.54, 95% CI 0.43–0.68]. After matching (n = 2181 matched pairs), VIV-TAVR was associated with lower odds of 30-day mortality (OR 0.41, 95% CI 0.23–0.74), 30-day morbidity (OR 0.53, 95% CI 0.43–0.72), and major bleeding (OR 0.66, 95% CI 0.51–0.85). Valve-in-valve TAVR was also associated with shorter length of stay (median savings of 2 days, 95% CI 1.3–2.7) and higher odds of routine home discharges (OR 2.11, 95% CI 1.61–2.78) compared to re-SAVR. Conclusion In this large, nationwide study of matched high-risk patients with degenerated bioprosthetic aortic valves, VIV-TAVR appears to confer an advantage over re-SAVR in terms of 30-day mortality, morbidity, and bleeding complications. Further studies are warranted to benchmark in low- and intermediate-risk patients and to adequately assess longer-term efficacy.

scholarly journals Managing Stroke During Transcatheter Aortic Valve Replacement

2017 ◽  
Vol 12 (01) ◽  
pp. 25 ◽  
Author(s):  
Florian Hecker ◽  
Mani Arsalan ◽  
Thomas Walther ◽  
◽  
◽  
...  
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Elevated Risk ◽  
Intermediate Risk ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Risk Patients

Transcatheter aortic valve replacement (TAVR) has become the default treatment option for high-risk patients with aortic stenosis and an alternative to surgical aortic valve replacement in intermediate-risk patients. There are, however, concerns regarding strokes during TAVR. Reported stroke rates vary strongly depending on the type of study, stroke definition, cohort and study period. Furthermore, stroke after TAVR occurs in three distinct phases: 1) early high-risk, directly procedure related; 2) elevated risk interval between day 2 and day 30; 3) late hazard interval. Each of these phases is caused by the different aetiologies of stroke. This review summarises the different aetiologies and potential strategies for managing stroke during TAVR.

Transcatheter Aortic Valve Replacement

2019 ◽  
pp. 175-184
Author(s):  
Melanie Mei Liu ◽  
Georg Burkhard Mackensen
Keyword(s):  
High Risk ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Intraoperative Imaging ◽  
Intermediate Risk ◽  
Transcatheter Aortic Valve ◽  
Risk Patients

Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with severe symptomatic aortic stenosis deemed high risk for surgery or inoperable, and its use has recently expanded to the treatment of intermediate-risk patients with severe symptomatic aortic stenosis as well as high-risk patients with a failing aortic valve bioprosthesis. As a key member of the interdisciplinary heart valve team involved in the care of the TAVR patient, the anesthesiologist must be familiar with the currently available devices, procedural steps, and intraoperative imaging requirements in order not only to provide the appropriate level of anesthesia and analgesia for any given patient and procedure but also to anticipate and treat the hemodynamic changes and possible complications that accompany it.

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