scholarly journals Impact of Incomplete Coronary Revascularization on Late Ischemic and Bleeding Events after Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 9 (7) ◽  
pp. 2267
Author(s):  
Adrien Carmona ◽  
Benjamin Marchandot ◽  
François Severac ◽  
Marion Kibler ◽  
Antonin Trimaille ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Coronary Revascularization ◽  
Bleeding Complications ◽  
Syntax Score ◽  
Bleeding Events ◽  
Transcatheter Aortic Valve

Background: The impact of coronary artery disease (CAD) and revascularization by percutaneous coronary intervention (PCI) on prognosis in patients undergoing transcatheter aortic valve replacement (TAVR) remain debated. A dismal prognosis in patients undergoing PCI has been associated with elevated baseline SYNTAX score (bSS) and residual SYNTAX score (rSS). The objective was to investigate whether the degree of bSS and rSS impacted ischemic and bleeding events after TAVR. Methods: bSS and rSS were calculated in 311 patients admitted for TAVR. The primary outcome was the occurrence of major adverse cardiac events (MACE), a composite endpoint of myocardial infarction, stroke, cardiovascular death, or rehospitalization for heart failure. The occurrence of late major/life-threatening bleeding complications (MLBCs) and each primary endpoint individually were the secondary endpoints. Results: bSS > 22 was associated with higher occurrence of MACE (p = 0.013). rSS > 8 and bSS > 22 had no impact on overall cardiovascular mortality. rSS > 8 and bSS > 22 were associated with higher rates of myocardial infarction (p = 0.001 and p = 0.004) and late occurrence of MLBCs. Multivariate analysis showed that bSS > 22 (sHR 2.48) and rSS > 8 (sHR 2.35) remained predictors of MLBCs but not of myocardial infarction. Conclusions: Incomplete coronary revascularization and CAD burden did not impact overall and cardiac mortality but constitute predictors of late MLBCs in TAVR patients.

Abstract 17539: Conventional vs. Transcatheter Aortic Valve Replacement - Propensity Score Adjusted Comparison of 3,751 Unselected Patients

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jochen Börgermann ◽  
Eric Emmel ◽  
Smita Scholtz ◽  
Stephan Ensminger ◽  
Werner Scholtz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Aortic Valve ◽  
Propensity Score ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Vascular Complications ◽  
Bleeding Complications ◽  
Moderate Risk ◽  
Transcatheter Aortic Valve

Background and Hypothesis: Transcatheter aortic valve replacement (TAVR) is an established method in high-risk patients. Two aspects of this procedure are currently under discussion: 1.) Do the data acquired from randomized studies and registers justify expansion of the procedure to include younger and healthier patients? 2.) Is the transfemoral approach superior to the transapical approach with regard to mortality and periprocedural complications? Against this background we examined the mortality and morbidity of all patients who received an isolated conventional, transapical or transfemoral aortic valve replacement in accordance with the criteria of the Valve Academic Research Consortium (VARC)-2. Methods: A prospective register was taken from a single center recording all conventional (CONV, n=2,881), transapical (TAVR-TA, n=363) and transfemoral (TAVR-TF, n=570) aortic valve implantations during the period from 07/2009 to 10/2014. Using propensity score (PS) matching, first CONV and TAVRall (TA+TF) and then TAVR-TA and TAVR-TF were paired on the basis of 21 risk variables, creating comparable groups. Results: 393 pairs CONV vs. TAVRall within a moderate risk could be created (EuroSCORE 18.7 vs. 18.5; STS 5.0 vs. 5.4). Comparison revealed no difference for 30d mortality (4.6% CONV vs. 5.1% TAVRall, p=0.74), stroke (2.8% vs. 2.0%, p=0.48) or myocardial infarction (0.0 vs. 0.3%, p=0.50). Bleeding complications were significantly more frequent in the CONV, SM implantations and vascular complications in the TAVRall group. In the PS-adjusted comparison TAVR-TA vs. TAVR-TF (289 pairs; EuroSCORE 25.1 vs. 22.1; STS 6.8 vs. 6.7) there was also no difference in the hard endpoints (30d mortality 4.9% TA vs. 4.2% TF, p=0.70; stroke 3.1% vs. 2.8%, p=0.81; myocardial infarction 0.4% vs. 0.4%, p=1.00). Here bleeding complications were significantly more frequent in the TA group, SM implantations and vascular complications in the TF group. Subgroup analyses show an advantage of the TAVR procedure in patients with high STS or low LVEF. Conclusions: These data show that 1.) conventional aortic valve replacement and TAVR are comparable in the moderate risk group, and 2.) the two approaches, transapical and transfemoral, produce comparable results.

scholarly journals Procedural outcomes in patients with dual versus single antiplatelet therapy prior to transcatheter aortic valve replacement

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hatim Seoudy ◽  
Maren Thomann ◽  
Johanne Frank ◽  
Matthias Lutz ◽  
Thomas Puehler ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antiplatelet Therapy ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Transcatheter Aortic Valve ◽  
Life Threatening ◽  
The Impact

AbstractThe impact of uninterrupted dual antiplatelet therapy (DAPT) on bleeding events among patients undergoing transcatheter aortic valve replacement (TAVR) has not been well studied. We conducted an analysis of 529 patients who underwent transfemoral TAVR in our centre and were receiving either DAPT or single antiplatelet therapy (SAPT) prior to the procedure. Accordingly, patients were grouped into a DAPT or SAPT group. Following current guidelines, patients in the SAPT group were switched to DAPT for 90 days after the procedure. The primary endpoint of our analysis was the incidence of bleeding events at 30 days according to the VARC-2 classification system. Any VARC-2 bleeding complications were found in 153 patients (28.9%), while major/life-threatening or disabling bleeding events occurred in 60 patients (11.3%). Our study revealed no significant difference between the DAPT vs. SAPT group regarding periprocedural bleeding complications. Based on multivariable analyses, major bleeding (HR 4.59, 95% CI 1.64–12.83, p = 0.004) and life-threatening/disabling bleeding (HR 8.66, 95% CI 3.31–22.65, p < 0.001) events were significantly associated with mortality at 90 days after TAVR. Both pre-existing DAPT and SAPT showed a comparable safety profile regarding periprocedural bleeding complications and mortality at 90 days. Thus, DAPT can be safely continued in patients undergoing transfemoral TAVR.

Abstract 15732: Transcatheter Aortic Valve Replacement as a Path to Transplant: Similar Short-term Outcomes in Liver and Renal Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hope Caughron ◽  
Devang Parikh ◽  
Zev Allison ◽  
Vaikom Mahadevan
Keyword(s):  
Renal Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Liver Transplant ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Control Group ◽  
Bleeding Events ◽  
Transcatheter Aortic Valve ◽  
End Stage

Introduction: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients with predicted poor surgical outcomes due to end stage liver disease (ESLD) or end stage renal disease (ESRD), though there remains minimal data regarding outcomes and treatment strategy in this population. This study evaluates in-hospital, 30-day, and 1-year outcomes after TAVR in a cohort of patients with ESLD and/or ESRD compared to a cohort without these comorbidities. Methods: We retrospectively compared 317 consecutive patients (N=37 ESLD and ESRD, N=286 without ESLD or ESRD) age >18 who underwent transfemoral or transssubclavian TAVR at University of California San Francisco Medical Center from August 1 st , 2014 to April 1 st , 2020. Results: The ESLD and ESRD group had younger patients (69.8±11.5 vs 79.1±9.8, p<0.01), a higher incidence of diabetes mellitus (54.8% vs 28.3%, p<0.01), and higher STS-PROM scores (7.8±6.5 vs 4.7±3.9, p<0.01). Comparing the ESLD and ESRD to the control group, there were similar rates of in-hospital cerebrovascular events (3.2% vs 3.5%, p=0.94), vascular complications (6.5% vs 7.0%, p=0.91), and mortality (0.0%, vs 1.7%, p=0.46) with more bleeding events at discharge (9.7% vs 2.1%, p=0.01) and 1-year (29.2% vs 10.4%, p=0.01). Mortality rates were similar at 30-days (3.2% vs 2.1%, p=0.69) and 6-months (3.4% vs 2.8%, p=0.83), with a trend towards higher mortality in the ESLD and ESRD group at 1-year (16.7% vs 7.8%, p=0.15) from primarily noncardiac causes. Readmission rates were higher in the ESLD and ESRD cohort at 6-months (58.6% vs 27.2%, p<0.01) and 1-year (66.7% vs 40.6%, p=0.02). One patient received dual kidney-liver transplant, 1 patient received a liver transplant, and 8 patients remain on the transplant wait-list. Conclusion: Patients with ESLD and ESRD who underwent TAVR had higher rates of bleeding events and noncardiovascular readmissions with similar rates of mortality at discharge, 30-days, and 6-months when compared to patients without these comorbidities. This study suggests that TAVR may be a safe path to transplant in patients with liver or renal failure and aortic valve pathology, though additional studies are necessary to confirm these findings.

Bleeding Complications Drive In-Hospital Mortality of Patients with Atrial Fibrillation after Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 120 (11) ◽  
pp. 1580-1586 ◽  
Author(s):  
Achim Lother ◽  
Klaus Kaier ◽  
Ingo Ahrens ◽  
Wolfgang Bothe ◽  
Dennis Wolf ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bleeding Complications ◽  
Hospital Outcome ◽  
Transcatheter Aortic Valve

Abstract Background Atrial fibrillation (AF) is a risk factor for poor postoperative outcome after transfemoral transcatheter aortic valve replacement (TF-TAVR). The present study analyses the outcomes after TF-TAVR in patients with or without AF and identifies independent predictors for in-hospital mortality in clinical practice. Methods and Results Among all 57,050 patients undergoing isolated TF-TAVR between 2008 and 2016 in Germany, 44.2% of patients (n = 25,309) had AF. Patients with AF were at higher risk for unfavorable in-hospital outcome after TAVR. Including all baseline characteristics for a risk-adjusted comparison, AF was an independent risk factor for in-hospital mortality after TAVR. Among patients with AF, EuroSCORE, New York Heart Association classification class, or renal disease had only moderate effects on mortality, while the occurrence of postprocedural stroke or moderate to major bleeding substantially increased in-hospital mortality (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.61–4.30, p < 0.001 and OR 3.12, 95% CI 2.68–3.62, p < 0.001). However, the strongest independent predictor for in-hospital mortality among patients with AF was severe bleeding (OR 18.00, 95% CI 15.22–21.30, p < 0.001). Conclusion The present study demonstrates that the incidence of bleeding defines the in-hospital outcome of patients with AF after TF-TAVR. Thus, the periprocedural phase demands particular care in bleeding prevention.

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