scholarly journals Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 10 (21) ◽  
pp. 4911
Author(s):  
Daniela Geisler ◽  
Piotr Nikodem Rudziński ◽  
Waseem Hasan ◽  
Martin Andreas ◽  
Ena Hasimbegovic ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
First Year ◽  
Transcatheter Aortic Valve ◽  
Multivariate Logistic Model ◽  
Heart Center ◽  
One Year ◽  
Economic Considerations

Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality.

Economic Considerations in Access to Transcatheter Aortic Valve Replacement

2022 ◽  
Author(s):  
Kriyana P. Reddy ◽  
Peter W. Groeneveld ◽  
Jay Giri ◽  
Alexander C. Fanaroff ◽  
Ashwin S. Nathan
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Socioeconomically Disadvantaged ◽  
Transcatheter Aortic Valve ◽  
Economic Considerations

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, with the number of procedures and sites offering the procedure steadily rising over the past decade in the United States. Despite this, growth into certain markets has been limited as hospitals have to balance high TAVR costs with the ability to offer a complete array of state-of-the-art therapies for aortic stenosis. This trade-off often results in decreased access to TAVR services by patients cared for in hospitals that cannot afford these services or have difficulty meeting procedural requirements, recruiting skilled physicians, and initiating and then maintaining a functioning TAVR program. The lack of access is more common among patients of color or those who are socioeconomically disadvantaged. The purpose of this review is to describe the hospital-level economic considerations of TAVR in the United States and the resulting effects on geographic, racial, ethnic, and socioeconomic access for Americans.

Abstract TP321: Performance of R 2 Cha 2 Ds 2 Vasc, Cha 2 Ds 2 Vasc, R 2 Chads 2 , and Chads 2 Scores for Predicting Stroke One Year After Transcatheter Aortic Valve Replacement

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Paul M Ndunda ◽  
Peter Tadros ◽  
Mark Wiley ◽  
Greg Muehlebach ◽  
George Zorn ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Clinical Care ◽  
Characteristic Curve ◽  
Discriminative Ability ◽  
Transcatheter Aortic Valve ◽  
Academic Center ◽  
One Year

Introduction: Stroke after transcatheter aortic valve replacement (TAVR) is a significant cause of morbidity and mortality. It increases the risk of mortality threefold, within one year of TAVR. It is also associated with significant disability and increased health care costs. A validated risk prediction tool for stroke one year after TAVR may be useful in risk stratification to guide decisions at the point of clinical care and in research. The objective of this study was to assess the calibration and discriminative ability of the R 2 CHA 2 DS 2 VASc, CHA 2 DS 2 VASc, R 2 CHADS 2 , and CHADS 2 scores for predicting stroke within one year of TAVR. Methods: This was a retrospective cohort study using data from a midwestern academic center TAVR program. Patients who underwent TAVR from 2012 to the first quarter of 2018 who had one-year follow-up data were included in the study. The model discrimination and calibration were assessed using the area under the receiver operating characteristic curve (c-statistic) and the Hosmer-Lemeshow test respectively. Results: Six hundred and sixty four patients met the inclusion criteria and 3.4% had stroke within one year of undergoing TAVR. They had a median age of 81 years and a mean STS score of 6.3. The R 2 CHA 2 DS 2 VASc, CHA 2 DS 2 VASc, R 2 CHADS 2 , and CHADS 2 scores had c-statistics of 0.591, 0.596, 0.607, and 0.622, respectively. The Hosmer-Lemeshow χ 2 p-values were 0.762, 0.422, 0.463 and 0.146 respectively. Conclusion: The CHADS 2 score had the best discriminative ability for stroke prediction one year after TAVR. All the four scores were well calibrated.

scholarly journals Incidence and outcome of prosthetic valve endocarditis after transcatheter aortic valve replacement in the Netherlands

2020 ◽  
Vol 28 (10) ◽  
pp. 520-525
Author(s):  
J. Brouwer ◽  
F. S. van den Brink ◽  
V. J. Nijenhuis ◽  
T. N. Vossenberg ◽  
R. Delewi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
The Netherlands ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
First Year ◽  
Transcatheter Aortic Valve

Abstract Background Transcatheter aortic valve replacement (TAVR) is increasingly being used as an alternative to conventional surgical valve replacement. Prosthetic valve endocarditis (PVE) is a rare but feared complication after TAVR, with reported first-year incidences varying from 0.57 to 3.1%. This study was performed to gain insight into the incidence and outcome of PVE after TAVR in the Netherlands. Methods A multicentre retrospective registry study was performed. All patients who underwent TAVR in the period 2010–2017 were screened for the diagnosis of infective endocarditis in the insurance database and checked for the presence of PVE before analysis of general characteristics, PVE parameters and outcome. Results A total of 3968 patients who underwent TAVR were screened for PVE. During a median follow-up of 33.5 months (interquartile range (IQR) 22.8–45.8), 16 patients suffered from PVE (0.4%), with a median time to onset of 177 days (IQR 67.8–721.3). First-year incidence was 0.24%, and the overall incidence rate was 0.14 events per 1000 person-years. Overall mortality during follow-up in our study was 31%, of which 25% occurred in hospital. All patients were treated conservatively with intravenous antibiotics alone, and none underwent a re-intervention. Other complications of PVE occurred in 5 patients (31%) and included aortic abscess (2), decompensated heart failure (2) and cerebral embolisation (1). Conclusion PVE in patients receiving TAVR is a relatively rare complication and has a high mortality rate.

Transcatheter aortic valve replacement with the Portico valve: one-year results of the early Canadian experience

2017 ◽  
Vol 12 (13) ◽  
pp. 1653-1659 ◽  
Author(s):  
Gidon Perlman ◽  
Anson Cheung ◽  
Eric Dumont ◽  
Dion Stub ◽  
Danny Dvir ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Canadian Experience ◽  
One Year
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