Association between Nutritional Status and Mortality after Aortic Valve Replacement Procedure in Elderly with Severe Aortic Stenosis

Background: There is still a lack of data on the nutritional status of older people with aortic stenosis (AS) and the effect of poor nutrition on the occurrence of complications and mortality after an aortic valve replacement (AVR) procedure. The aim of this study was to assess the impact of selected nutritional status parameters in elderly patients with severe AS on the occurrence of postoperative complications and one-year mortality after the AVR procedure. Methods: 101 elderly patients with AS aged 74.6 ± 5.2 years who qualified for surgical treatment (aortic valve area [AVA] 0.73 ± 0.2 cm2) were enrolled in the study. A nutritional status assessment was performed before AVR surgery, and the frequency of postoperative complications occurring within 30 days of surgery was assessed. The one-year mortality rate was also captured. Results: Adverse events (both major and minor) up to 30 days occurred in 49.5% (n = 50) of the study population. Low Mini Nutritional Assessment (f-MNA) and Subjective Global Assessment (7-SGA) scores and low concentrations of total cholesterol, LDL-cholesterol, and prealbumin were associated with a higher risk of postoperative complications. The risk of complications increased 1.22 times (95% CI; 1.030–1.453; p = 0.019) with an impaired nutritional status. The annual mortality rate in the study group was 7.9%. Unintentional weight loss of >2.8% in the six months preceding surgery proved useful for predicting death within the first year after AVR surgery. Conclusions: The results indicate that poor nutritional status is an important factor affecting the adverse outcomes in elderly patients with severe aortic valve stenosis undergoing an AVR procedure.

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SUN-P177: The Relationship between Nutritional Status and Postoperative Complications after Aortic Valve Replacement Due to Aortic Stenosis in Elderly Patients

Clinical Nutrition ◽

10.1016/s0261-5614(17)30451-x ◽

2017 ◽

Vol 36 ◽

pp. S119

Author(s):

E.W. Wernio ◽

S. Małgorzewicz ◽

D. Jagielak

Keyword(s):

Postoperative Complications ◽

Aortic Valve ◽

Aortic Stenosis ◽

Nutritional Status ◽

Aortic Valve Replacement ◽

Elderly Patients ◽

Valve Replacement ◽

The Relationship

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Faculty Opinions recommendation of One-year outcomes of the Surgical Treatment of Aortic Stenosis With a Next Generation Surgical Aortic Valve (TRITON) trial: a prospective multicenter study of rapid-deployment aortic valve replacement with the EDWARDS INTUITY Valve System.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717962045.793465543 ◽

2012 ◽

Cited By ~ 1

Author(s):

Bernard Prendergast ◽

Margaret Loudon

Keyword(s):

Surgical Treatment ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Multicenter Study ◽

Prospective Multicenter Study ◽

Valve System ◽

One Year ◽

Rapid Deployment

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True-severe stenosis in paradoxical low-flow low-gradient aortic stenosis: outcomes after transcatheter aortic valve replacement

European Heart Journal - Quality of Care and Clinical Outcomes ◽

10.1093/ehjqcco/qcab010 ◽

2021 ◽

Author(s):

Taishi Okuno ◽

Noé Corpataux ◽

Giancarlo Spano ◽

Christoph Gräni ◽

Dik Heg ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Functional Status ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Low Flow ◽

Aortic Valve Area ◽

High Gradient ◽

Transcatheter Aortic Valve

Abstract Aims The ESC/EACTS guidelines propose criteria that determine the likelihood of true-severe aortic stenosis (AS). We aimed to investigate the impact of the guideline-based criteria of the likelihood of true-severe AS in patients with low-flow low-gradient (LFLG) AS with preserved ejection fraction (pEF) on outcomes following transcatheter aortic valve replacement (TAVR). Methods and results In a prospective TAVR registry, LFLG-AS patients with pEF were retrospectively categorized into high (criteria ≥6) and intermediate (criteria <6) likelihood of true-severe AS. Haemodynamic, functional, and clinical outcomes were compared with high-gradient AS patients with pEF. Among 632 eligible patients, 202 fulfilled diagnostic criteria for LFLG-AS. Significant haemodynamic improvement after TAVR was observed in LFLG-AS patients, irrespective of the likelihood. Although >70% of LFLG-AS patients had functional improvement, impaired functional status [New York Heart Association (NYHA III/IV)] persisted more frequently at 1 year in LFLG-AS than in high-gradient AS patients (7.8%), irrespective of the likelihood (high: 17.4%, P = 0.006; intermediate: 21.1%, P < 0.001). All-cause death at 1 year occurred in 6.6% of high-gradient AS patients, 10.9% of LFLG-AS patients with high likelihood [hazard ratio (HR)adj 1.43, 95% confidence interval (CI) 0.68–3.02], and in 7.2% of those with intermediate likelihood (HRadj 0.92, 95% CI 0.39–2.18). Among the criteria, only the absence of aortic valve area ≤0.8 cm2 emerged as an independent predictor of treatment futility, a combined endpoint of all-cause death or NYHA III/IV at 1 year (OR 2.70, 95% CI 1.14–6.25). Conclusion Patients with LFLG-AS with pEF had comparable survival but worse functional status at 1 year than high-gradient AS with pEF, irrespective of the likelihood of true-severe AS. Clinical Trial Registration https://www.clinicaltrials.gov. NCT01368250.

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Regression of left ventricular mass one year after aortic valve replacement for pure severe aortic stenosis

The American Journal of Cardiology ◽

10.1016/s0002-9149(01)02262-7 ◽

2002 ◽

Vol 89 (4) ◽

pp. 408-413 ◽

Cited By ~ 27

Author(s):

Harald P Kühl ◽

Andreas Franke ◽

David Puschmann ◽

Friedrich A Schöndube ◽

Rainer Hoffmann ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Left Ventricular Mass ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Ventricular Mass ◽

One Year

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Abstract 155: Prevalence and Clinical Correlates of Left Ventricular Hypertrophy by Sokolow-Lyon and Cornell Electrocardiogram Voltage Criteria in Transcatheter Aortic Valve Replacement Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.155 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Emily Xiao ◽

Augustin Delago ◽

Mohammad El-Hajjar ◽

Batyrjan Bulibek ◽

Mikhail Torosoff

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Retrospective Chart Review ◽

Left Ventricular ◽

Aortic Valve Area ◽

Chi Square ◽

Cornell Voltage

Background and Hypothesis: The sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. LVH is expected in the TAVR population and would be reflected in voltage criteria by ECG. Methods: A retrospective chart review was conducted in 176 consecutive TAVR patients without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 19% (33 of 176) of patients; in 49% (86 of 176) of patients, neither criteria was suggestive for LVH. Only 19% (34 of 176) of patients had LVH by Cornell Voltage and 13% (23 of 176) by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001). Ejection fraction, aortic valve gradient, aortic valve area, COPD, PVD, prior stroke, dyslipidemia, and hypertension did not affect the prevalence of LVH by either or both criteria. Women (p<0.01) and patients with rhythm other than atrial fibrillation (p<0.0053) were more likely to have voltage criteria for LVH, while older adults were more likely to meet criteria for LVH. Concordant LVH criteria were noted in patients 84.6 +/- 7.2 years of age, while patients without LVH by ECG voltage criteria were significantly younger at 80.21 +/- 8.1 years of age (p<0.007). Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH and critical aortic stenosis in TAVR patients. Women are more likely to have voltage criteria for LVH. Therefore, ECG may not be a suitable method of screening patients with severe aortic stenosis for LVH, especially in men.

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Abstract 2066: Does Mitral Regurgitation Regress After Aortic Valve Replacement For Aortic Stenosis ? A Prospective Multicenter Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_447-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Philippe Unger ◽

Danièle Plein ◽

Bernard Cosyns ◽

Guy Van Camp ◽

Olivier Xhaët ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Aortic Valve Area ◽

Regurgitant Volume ◽

Lv Ejection Fraction

Background: Mitral regurgitation (MR) is common in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). Whether its severity may decrease after AVR remains controversial. Previous studies were mainly retrospective and the degree of MR was assessed at best semi-quantitatively. This study sought to prospectively and quantitatively assess how AVR may affect MR severity. Methods: Patients with AS scheduled for isolated AVR and presenting holosystolic MR which was not considered for replacement or repair were included. Previous mitral valve surgery; severe aortic regurgitation and poor acoustic windows were excluded. Thirty-five patients (mean age 77±7 years) were studied before (median 1, range 1– 41 days) and after AVR (median 7, range 4 –19 days). All patients underwent a comprehensive echocardiographic examination; MR was assessed by Doppler echocardiography using color flow mapping of the regurgitant jet and the PISA method. No patient had prolapsed or flail mitral leaflet as mechanism of MR. Results: Preoperative maximal and mean transaortic pressure gradients and aortic valve area were 74±26 mmHg, 44±16 mmHg, and 0.57±0.18 cm 2 , respectively. Left ventricular (LV) ejection fraction increased from 49±16 % to 55±15 % after AVR (p<0.001). LV end-diastolic volume decreased from 91±32 ml to 77±30 ml (p<0.001).The ratio of MR jet to left atrial area decreased from 30±16% to 20±14% (p<0.001). MR effective regurgitant orifice (ERO) and regurgitant volume decreased from 10±5 mm 2 to 8±6 mm 2 (p=0.015) and from 19±10 ml to 11±9 ml (p<0.0001). The decrease in ERO and in regurgitant volume was similar in patients with preserved or depressed LV ejection fraction (≤45 %) (2±3 vs 3±6 mm 2 and 7±9 vs 8±7 ml; p=NS, respectively). Conclusions: AVR is associated with an early postoperative reduction of the quantified degree of MR. This mainly results from a decrease in regurgitant volume and only modestly from a reduction in ERO, emphasizing the contributing role of the decrease in driving pressure accross the mitral regurgitant orifice.

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Abstract 6190: Outcomes of Carotid Stenting in Patients with Concomitant Severe Carotid and Aortic Stenosis Prior to Aortic Valve Replacement

Circulation ◽

10.1161/circ.118.suppl_18.s_1078 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Subrata Kar ◽

Mehdi H Shishehbor ◽

E. Murat Tuzcu ◽

Deepak L Bhatt ◽

Christopher Bajzer ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Open Heart Surgery ◽

Cleveland Clinic ◽

Carotid Stenting ◽

Aortic Valve Area ◽

Close Monitoring ◽

The Mean

Introduction: Carotid stenosis increases the risk for perioperative stroke during open heart surgery. Patients with concomitant severe carotid and aortic stenosis (AS) are frequently referred for carotid intervention prior to aortic valve replacement. Hypothesis: We hypothesized that carotid stenting can be safe and efficacious in the setting of severe AS. Methods: Of the total of 829 consecutive patients that underwent carotid interventions from 1998 –2005 at the Cleveland Clinic, 52 patients (65% male, age 78.82 ± 26.16 years) with severe AS (aortic valve area ≤ 1.0 cm 2 , 0.71 ± 0.15 cm 2 ) were included. Demographic, echocardiographic, and angiographic data were obtained prospectively. Our primary endpoints were stroke, transient ischemic attacks (TIAs), or death. Results: The mean STS Mortality scores for all groups were 6.85 ± 4.53% (n=46), six patient scores were immeasurable. There were no procedural strokes or mortality. TIA occurred in 1 patient during carotid stenting. Thirty day mortality was 6% (2 patients with LV-EF <20% died from heart failure and arrhythmia and 1 died from pulmonary embolism). Two other patients with depressed EF expired >30 days after carotid stenting prior to planned aortic valve replacement (AVR). AVR was performed in 29 of the 52 patients (26 patients ≥ 30 days post carotid stenting and 3 patients <15 days post carotid stenting). Of the remaining 23 patients, AVR was not performed due to death (n=5), high surgical risk from medical comorbidities (n=7), and patient refusal (n=3). Close monitoring and reassessment was recommended in 8 patients with asymptomatic AS. The mean STS mortality scores for patients who underwent AVR and who did not have AVR were 6.88 ± 5.05% and 6.81 ± 4.08% respectively (p=ns). Conclusions: Carotid interventions can be safely accomplished in patients with severe AS prior to AVR.

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