scholarly journals Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

2021 ◽  
Vol 10 (19) ◽  
pp. 4563
Author(s):  
Marisa Avvedimento ◽  
Anna Franzone ◽  
Attilio Leone ◽  
Raffaele Piccolo ◽  
Domenico Simone Castiello ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Right Ventricular ◽  
Right Ventricular Function ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Stage 4 ◽  
Secondary Endpoints ◽  
Aortic Valve Implantation ◽  
Valve Implantation

(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.

scholarly journals Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

2021 ◽  
Author(s):  
Marisa Avvedimento ◽  
Anna Franzone ◽  
Attilio Leone ◽  
Raffaele Piccolo ◽  
Domenico Simone Castiello ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Right Ventricular ◽  
Right Ventricular Function ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Stage 4 ◽  
Secondary Endpoints ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract PurposeWe sought to assess the prognostic role of the extent of cardiac damage among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).MethodsA staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-day after TAVI. All-cause mortality at 1-year was the primary endpoint of the study. Cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis and re-hospitalization for all caused were included as secondary endpoints. ResultsAt baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-day after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p= 0.08). No differences were found in secondary endpoints. ConclusionsAlthough TAVI might be associated with an amelioration of the left ventricular diastolic and right ventricular function, patients with a greater extent of cardiac damage at baseline are at higher risk of mortality at 1-year after the procedure.

scholarly journals Complex cardiac surgery in a high-risk patient with new-onset severe mitral regurgitation and aorta to right ventricular fistula after transcatheter aortic valve implantation: a case report

2020 ◽  
Vol 4 (5) ◽  
pp. 1-5
Author(s):  
Mario Verdugo-Marchese ◽  
Pierre Monney ◽  
Olivier Muller ◽  
Matthias Kirsch
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
High Risk ◽  
Aortic Valve ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Risk Patients ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) is the procedure of choice for aortic stenosis in high surgical risk patients, but it is no free from complications. Case summary A 86-year-old patient with severe aortic stenosis underwent TAVI 3 years ago with an Edwards Sapiens valve by femoral access. In the echocardiography follow-up, an aorta–right ventricular (Ao-RV) fistula was noted with restrictive flow and no significant shunt and it was treated conservatively. Three years after TAVI, the patient underwent cardiac surgery because of worsening heart failure due to a severe degenerative mitral regurgitation with tethering of P2 due to left ventricular remodelling, a posterior jet of severe regurgitation, and left ventricular dilatation. Surgical replacement of the TAVI and aortic root with a bioprosthesis (Medtronic Freestyle) and direct closure of the fistula was performed along with the mitral valve replacement. The patient was discharged with a good clinical result and no evidence of remaining Ao-RV fistula at transthoracic echocardiography. Discussion Aorta–right ventricular fistula is a rare entity. Most reported cases arise after rupture of a congenital coronary sinus aneurism, endocarditis, trauma, and aortic valve or aortic root surgery. This is the 10th reported case after TAVI (9 after an Edwards Sapiens TAVI). Non-significant shunt can be treated conservatively but development of heart failure and death are described in significant shunts. Balloon post-dilatation and the absence of surgical calcium debridement inherent to TAVI may theoretically contribute to the development of the fistula. Surgical replacement and closure of the fistula is a therapeutic option for this entity even in high-risk patients.

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