Impact of Pre-procedural Cerebrovascular Events on Clinical Outcomes After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis

Background: Transcatheter aortic valve implantation (TAVI) is an increasingly common treatment of symptomatic severe aortic valve stenosis (AS). Thus, it is reasonable to carefully investigate the impact of individual clinical factors on outcomes after TAVI. Objectives: We aimed to investigate the impact of the previous cerebro-vascular events (CVEs) on outcomes of patients with severe AS undergoing TAVI. Methods: A total of 148 consecutive patients scheduled for TAVI were included and stratified as with and without a history of CVEs (stroke or transient ischemic attack). Frailty features were also assessed. The primary endpoint was a 12-month all-cause mortality. Results: Seventeen (11.5%) patients had a history of CVEs (the CVE group). At 30 days and 12 months, all-cause mortality was higher in the CVE group [30-day: 5 (29.4%) vs. 7 (5.3%); p=0.005; 12-month: 9 (52.9%) vs. 13 (9.9%); p=0.001]. Similarly, at the longest available follow-up, mortality was higher in the CVE group [10 (58.8%) vs. 23 (17.6%); p=0.001]. Similar rates of other complications after TAVI were noted, apart from inhospital acute kidney injury (AKI) grade 3 [3 (17.6%) vs. 5 (3.8%); p=0.049] and blood transfusions [9 (52.9%) vs. 35 (26.7%); p=0.026]. Results of 5MWT and Katz index assessment indicated a greater level of frailty in the CVE group. There were no differences in subsequent events including CVEs, bleeding, myocardial infarction, and new-onset of atrial fibrillation (AF) at 12 months between the groups. Conclusion: We showed that a history of CVEs in patients with severe AS undergoing TAVI is associated with a higher long-term mortality.

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Survival, Functional Capacity and Quality of Life after Transcatheter Aortic Valve Implantation: Present Considerations and Future Perspectives

Romanian Journal of Cardiology ◽

10.47803/rjc.2021.31.2.319 ◽

2021 ◽

Vol 31 (2) ◽

pp. 319-325

Author(s):

Crina-Ioana RADULESCU ◽

Dan DELEANU ◽

Ovidiu CHIONCEL

Keyword(s):

Quality Of Life ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

Age Related ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

The Impact

Severe aortic stenosis (AS) is the most common valvular heart disease, with an increasing prevalence due to age-related degenerative modifi cations of the valve. Once AS becomes symptomatic, the survival of patients is significantly reduced with an annual mortality rate of 25%. Depending on surgical risk, anatomical and technical aspects, and the patient’s option, correction can be made either by surgical valve replacement (SAVR) or by transcatheter aortic valve implantation (TAVI). Although aortic valve implantation brings relief of symptoms, there is little data on the quality of life (QoL) of patients undergoing TAVI and the factors that directly influence it. Even if age and comorbidities are known modifiers of survival, there is no specific tool to assess the impact of AS and to determine the appropriate treatment strategy.

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Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz275 ◽

2019 ◽

Vol 40 (38) ◽

pp. 3143-3153 ◽

Cited By ~ 83

Author(s):

George C M Siontis ◽

Pavel Overtchouk ◽

Thomas J Cahill ◽

Thomas Modine ◽

Bernard Prendergast ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Surgical Aortic Valve Replacement ◽

Surgical Risk ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Aims Owing to new evidence from randomized controlled trials (RCTs) in low-risk patients with severe aortic stenosis, we compared the collective safety and efficacy of transcatheter aortic valve implantation (TAVI) vs. surgical aortic valve replacement (SAVR) across the entire spectrum of surgical risk patients. Methods and results The meta-analysis is registered with PROSPERO (CRD42016037273). We identified RCTs comparing TAVI with SAVR in patients with severe aortic stenosis reporting at different follow-up periods. We extracted trial, patient, intervention, and outcome characteristics following predefined criteria. The primary outcome was all-cause mortality up to 2 years for the main analysis. Seven trials that randomly assigned 8020 participants to TAVI (4014 patients) and SAVR (4006 patients) were included. The combined mean STS score in the TAVI arm was 9.4%, 5.1%, and 2.0% for high-, intermediate-, and low surgical risk trials, respectively. Transcatheter aortic valve implantation was associated with a significant reduction of all-cause mortality compared to SAVR {hazard ratio [HR] 0.88 [95% confidence interval (CI) 0.78–0.99], P = 0.030}; an effect that was consistent across the entire spectrum of surgical risk (P-for-interaction = 0.410) and irrespective of type of transcatheter heart valve (THV) system (P-for-interaction = 0.674). Transcatheter aortic valve implantation resulted in lower risk of strokes [HR 0.81 (95% CI 0.68–0.98), P = 0.028]. Surgical aortic valve replacement was associated with a lower risk of major vascular complications [HR 1.99 (95% CI 1.34–2.93), P = 0.001] and permanent pacemaker implantations [HR 2.27 (95% CI 1.47–3.64), P < 0.001] compared to TAVI. Conclusion Compared with SAVR, TAVI is associated with reduction in all-cause mortality and stroke up to 2 years irrespective of baseline surgical risk and type of THV system.

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Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry

BMJ Open ◽

10.1136/bmjopen-2020-044319 ◽

2021 ◽

Vol 11 (6) ◽

pp. e044319

Author(s):

Fumiaki Yashima ◽

Masahiko Hara ◽

Taku Inohara ◽

Masahiro Jinzaki ◽

Hideyuki Shimizu ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Observational Study ◽

Transcatheter Aortic Valve Implantation ◽

Cardiovascular Mortality ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

The Impact

ObjectiveData on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm mortality of TAVI patients.DesignObservational study.SettingThis study included patients with AS from a Japanese multicentre registry who underwent TAVI.ParticipantsThe overall cohort included 2588 patients (84.4±5.2 years); majority were women (69.3%). The Society of Thoracic Surgeons risk score was 6.55% (IQR 4.55%–9.50%), the Euro II score was 3.74% (IQR 2.34%–6.02%) and the Clinical Frailty Scale score was 3.9±1.2.InterventionsWe classified patients based on statin at admission and identified 936 matched pairs after propensity score matching.Primary and secondary outcome measuresThe outcomes were all-cause and cardiovascular mortality.ResultsThe median follow-up was 660 days. Statin at admission was associated with a significant reduction in all-cause mortality (adjusted HR (aHR) 0.76, 95% CI 0.58 to 0.99, p=0.04) and cardiovascular mortality (aHR 0.64, 95% CI 0.42 to 0.97, p=0.04). In the octogenarians, statin was associated with significantly lower all-cause mortality (aHR 0.87, 95% CI 0.75 to 0.99, p=0.04); however, the impact in the nonagenarians appeared to be lower (aHR 0.84, 95% CI 0.62 to 1.13, p=0.25). Comparing four groups according to previous coronary artery disease (CAD) and statin, there was a significant difference in all-cause mortality, and patients who did not receive statin despite previous CAD showed the worst prognosis (aHR 1.33, 95% CI 1.12 to 1.57 (patients who received statin without previous CAD as a reference), p<0.01).ConclusionsStatin for TAVI patients will be beneficial even in octogenarians, but the benefits may disappear in nonagenarians. In addition, statin will be essential for TAVI patients with CAD. Further research is warranted to confirm and generalise our findings since this study has the inherent limitations of an observational study and included only Japanese patients.Trial registration numberUMIN000020423.

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Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Interventional Cardiology Review ◽

10.15420/icr.2019.24 ◽

2020 ◽

Vol 15 ◽

Cited By ~ 3

Author(s):

Antonio Greco ◽

Davide Capodanno

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Current Status ◽

Low Grade ◽

Bleeding Events ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

The Impact

Transcatheter aortic valve implantation (TAVI) is the standard of care for symptomatic severe aortic stenosis. Antithrombotic therapy is required after TAVI to prevent thrombotic complications but it increases the risk of bleeding events. Current clinical guidelines are mostly driven by expert opinion and therefore yield low-grade recommendations. The optimal antithrombotic regimen following TAVI has yet to be determined and several randomised controlled trials assessing this issue are ongoing. The purpose of this article is to critically explore the impact of antithrombotic drugs, especially anticoagulants, on long-term clinical outcomes following successful TAVI.

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P3700Left trial appendage thrombosis in patients with severe aortic stenosis treated by transfemoral transcatheter aortic valve implantation

European Heart Journal ◽

10.1093/eurheartj/ehz745.0554 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N Mangner ◽

G Stachel ◽

F Woitek ◽

L Crusius ◽

S Haussig ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Univariate Analysis ◽

Academic Research ◽

Disease Stage ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

The Impact

Abstract Introduction Data about the impact of left atrial appendage thrombosis (LAAT) on early safety and midterm mortality in patients undergoing transfemoral (TF) transcatheter aortic valve implantation (TAVI) are scarce. Purpose To investigate the incidence and predictors of LAAT as well as the outcome associated with this condition in a large cohort of patients treated by TF-TAVI. Methods Patients receiving TF-TAVI for native aortic valve stenosis or failed aortic bioprostheses were stratified according to the presence of LAAT diagnosed by transoesophageal echocardiography. Early safety at 30-days according to Valve Academic Research Consortium-2 (VARC-2) and 2-year all-cause mortality were the primary outcome measures. Results From 02/2006 to 06/2016, 2.527 patients (88.5%) out of 2.854 patients treated by TF-TAVI had an available transesophageal echocardiography (TEE) at baseline and formed the analysis cohort. LAAT was found in 7.6% of the whole cohort and in 16.6% in those patients with known pre-existing atrial fibrillation (AF cohort). Patients with LAAT appeared to be sicker compared to controls indicated by a higher STS-Score and burden of comorbidities. Neither VARC-2 defined early safety at 30-days nor the rate of stroke was different between LAAT and controls in both the whole (early safety: 24.2% vs. 29.2%, p=0.123; stroke: 4.7% vs. 5.9%, p=0.495) and AF cohort (early safety: 22.9% vs. 29.1%, p=0.072; stroke: 3.3% vs. 5.6%, p=0.142). Evaluating the whole cohort in a univariate analysis, the 2-year mortality was significantly higher in LAAT compared to controls (HR 1.41 [95% CI 1.07–1.86], p=0.014). However, a multivariate analysis of the whole cohort and a separate examination of the AF cohort revealed no association between LAAT and 2-year mortality. Conclusion LAAT was frequent in patients undergoing TF-TAVI, in particular in patients with a history of AF, but it was not associated with an increase in periprocedural complications. The fact that LAAT was no independent predictor of mortality indicates that it should be interpreted as a marker of an advanced disease stage rather than a prognostic factor.

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134 Impact of COVID-19 pandemic on timing and early clinical outcomes of transcatheter aortic valve implantation

European Heart Journal Supplements ◽

10.1093/eurheartj/suab134 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Domenico Angellotti ◽

Rachele Manzo ◽

Anna Franzone ◽

Giovanni Esposito ◽

Marisa Avvedimento ◽

...

Keyword(s):

Aortic Valve ◽

Clinical Outcomes ◽

Transcatheter Aortic Valve Implantation ◽

Time Lag ◽

Clinical Profile ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

Aortic Valve Implantation ◽

Valve Implantation ◽

The Impact

Abstract Aims COVID-19 pandemic deeply changed the management of patients with aortic stenosis. Many cardiac societies have drawn up guidelines for the optimal management of this population but applicability of such recommendations in the current clinical practice and their impact on clinical outcomes has not been adequately investigated. Methods and results A single-centre retrospective study included 315 patients undergoing transcatheter aortic valve implantation (TAVI) between April 2017 and June 2021. To analyse the impact of hospitalization pathways during the pandemic on clinical outcomes of TAVI patients, study population was divided into two groups (pre-pandemic and pandemic groups) and all perioperative/follow-up data were compared. The primary endpoint was all-cause mortality at 30 days; secondary endpoints included procedural success and short- term complications. Pandemic group patients showed a more complex baseline clinical profile (NYHA III–IV, 70.1% vs. 56.3%; P = 0.03). The overall time to procedure was significantly longer during pandemic (56.9 ± 68.3 vs.37.7 ± 25.4; P = 0.004) while intensive care unit stay was shorter (2.2 ± 1.4 vs. 3.3 ± 3.5). Hospitalization length was similar in both group as well as all-cause mortality rate and the incidence of major periprocedural complications. Conclusions COVID-19 pandemic did not affect the safety and effectiveness of TAVI as similar rates of procedural complications and all-cause mortality were reported than before February 2020. Despite the increased time lag between diagnosis and procedure and a more complex clinical profile of patients at baseline, the revised pathway of hospitalization allowed to resume inpatient procedures while not affecting patients’ and healthcare workers’ safety.

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P1848Prevalence and outcomes in patients with Heyde syndrome after transcatheter aortic valve implantation, a single centre experience

European Heart Journal ◽

10.1093/eurheartj/ehz748.0599 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Waldschmidt ◽

A Drolz ◽

P Heimburg ◽

A Gossling ◽

N Schofer ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Bleeding Complications ◽

Transcatheter Aortic Valve ◽

Number Of Patients ◽

History Of ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Introduction Heyde syndrome is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. To date only few data exist regarding the prevalence of Heyde syndrome and results after transcatheter aortic valve implantation (TAVI) for the treatment of AS. Purpose We sought to evaluate the prevalence of Heyde syndrome in a routine clinical cohort of patients undergoing TAVI and analyze the effectiveness of treatment of AS regarding recurrent GIB in these patients. Methods We conducted a retrospective single-center analysis of 2545 consecutive patients who underwent TAVI for the treatment of AS in 2008–2017. Patients with a history of GIB were identified. The diagnosis of Heyde syndrome was defined as a clinical triad of presence of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. GIB of unknown origin or related to other causes was defined as bleeding unrelated to angiodysplasia. Clinical outcomes of patients with Heyde syndrome were evaluated with emphasis on bleeding complications and recurrence of GIB. Results A history of GIB prior to TAVI was detected in 190 patients (7.5%) of the TAVI cohort. Among them, 143 patients had a GIB unrelated to angiodysplasia (5.6%) and 47 patients (1.8%) were diagnosed with Heyde syndrome. Median age and STS-PROM were 80.7 (75.3, 84.0) years and 4.7 (2.7, 9.0) respectively in Heyde patients. TAVI was successfully performed in all cases (66% endovascular access, 34% transapical access). The effective orifice areas increased from 0.8±0.1 cm2 to 2.1±0.5 cm2. Periprocedural major/life-threatening bleeding was found in 6 patients (12.8%), mainly access-related and none due to GIB. In 51% of Heyde-patients transfusion of 4.5±5.7 packed red blood cells was required during the index hospitalisation. During a mean follow-up of 12 months, recurrent GIB after TAVI was detected in 32% of patients with Heyde syndrome. In contrast only 18% of patients with GIB unrelated to angiodysplasia (Non-Heyde) had recurrent GIB after TAVI. In patients diagnosed with Heyde syndrome and recurrent GIB after TAVI the rate of residual mild or moderate paravalvular regurgitation was higher compared to those with an unremarkable course (73% vs. 37%, p=0.045). Figure 1. 1-year Follow-Up Conclusions A relevant number of patients presenting for treatment of AS can be diagnosed with Heyde syndrome. In these patients TAVI can be successfully performed with moderate incidence of periprocedural bleeding complications but significant transfusion rates. Regardless of successful treatment of AS, recurrent GIB was detected in a significant number of Heyde patients during follow-up. The possible association with residual paravalvular regurgitation requires further investigation to improve treatment options in patients with Heyde syndrome.

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Management and Prevention of Vascular Complications Related to Transcatheter Aortic Valve Implantation and Aortic Aneurysm Repair Procedures – A Technical Note

Interventional Cardiology Review ◽

10.15420/icr.2010.5.1.81 ◽

2010 ◽

Vol 5 (1) ◽

pp. 81

Author(s):

Andrea Pacchioni ◽

Dimitris Nikas ◽

Carlo Penzo ◽

Salvatore Saccà ◽

Luca Favero ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Aneurysm ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Vascular Complications ◽

Technical Note ◽

Closure Device ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) and endovascular aortic repair (EVAR) are increasingly being used as therapeutic options for patients with severe aortic stenosis who are ineligible for surgery and who have aortic aneurysm with suitable anatomical features. These procedures can be associated with severe complications, especially related to vascular access and the use of a large introducer sheath (from 18 to 24 French [Fr]). In this article we describe possible vascular complications emerging during TAVI and EVAR and their appropriate management, beginning with patient selection, the correct way to perform vessel puncture and the use of a vascular closure device, up to the recently proposed cross-over technique, which is thought to minimise the risk of dangerous consequences of vascular damage.

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