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1
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D'Angelo T, Lanzafame LRM, Liguori C, Mantini C, Russo V, Palumbo P, Scalera GB, Iozzelli A, Borghesi A, Matta G, Greco F, Garretto V, Danti M, Iezzi R, Francone M. Pre-TAVI imaging: an Italian survey by the CT PRotocol optimization (CT-PRO) group. Int J Cardiovasc Imaging 2024; 40:831-839. [PMID: 38263535 PMCID: PMC11052815 DOI: 10.1007/s10554-024-03052-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/07/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE The purpose of this survey was to evaluate the current state-of-art of pre-TAVI imaging in a large radiological professional community. METHODS Between December 2022 and January 2023 all members of the Italian Society of Medical and Interventional Radiology (SIRM) were invited by the CT PRotocol Optimization group (CT-PRO group) to complete an online 24-item questionnaire about pre-TAVI imaging. RESULTS 557 SIRM members participated in the survey. The greatest part of respondents were consultant radiologists employed in public hospitals and 84% claimed to routinely perform pre-TAVI imaging at their institutions. The most widespread acquisition protocol consisted of an ECG-gated CT angiography (CTA) scan of the aortic root and heart followed by a non-ECG-synchronized CTA of the thorax, abdomen, and pelvis. Contrast agent administration was generally tailored on the patient's body weight with a preference for using high concentration contrast media. The reports were commonly written by radiologists with expertise in cardiovascular imaging, and included all the measurements suggested by current guidelines for adequate pre-procedural planning. About 60% of the subjects affirmed that the Heart Team is present at their institutions, however only 7% of the respondents regularly attended the multidisciplinary meetings. CONCLUSIONS This survey defines the current pre-TAVI imaging practice in a large radiological professional community. Interestingly, despite the majority of radiologists follow the current guidelines regarding acquisition and reporting of pre-TAVI imaging studies, there is still a noteworthy absence from multidisciplinary meetings and from the Heart Team.
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Affiliation(s)
- Tommaso D'Angelo
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy.
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
| | - Ludovica R M Lanzafame
- Unit of Diagnostic and Interventional Imaging, Department BIOMORF, University of Messina, Via Consolare Valeria 1, Messina, 98100, Italy
| | - Carlo Liguori
- Radiology Unit, Ospedale del Mare, ASL NA1 Centro, Napoli, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "Gabriele D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Vincenzo Russo
- Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Radiology Department IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierpaolo Palumbo
- Department of Diagnostic Imaging, Area of Cardiovascular and Interventional Imaging, Abruzzo Health Unit 1, L'Aquila, Italy
| | - Giovanni B Scalera
- Unit of Diagnostic Imaging, Department of Medicine and Surgery, Santa Maria della Misericordia Hospital, University of Perugia, Perugia, Italy
| | | | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, Brescia, I - 25123, Italy
| | - Gildo Matta
- Department of Radiology, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy
| | - Fabio Greco
- Department of Radiology, "University Hospitals Bristol and Weston Foundation Trust", Bristol, UK
| | - Valeria Garretto
- Diagnostic Radiology Unit Department, CAST - Policlinico - San Marco Hospital University, Catania, Italy
| | | | - Roberto Iezzi
- Unit of Diagnostic and Interventional Imaging, Department of Diagnostic Imaging, Radiation Therapy and Hematology, IRCCS Policlinico "A. Gemelli", Roma, Italy
- Unit of Radiology, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Marco Francone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Gomis M, Fernández C, Dacosta-Aguayo R, Carrillo X, Martínez S, Guijosa CM, Berastegui E, Valentín AG, Puig J, Bernal E, Ramos A, Cáceres C. Aortic valve Replacement compared to Transcatheter Implant and its relationship with COgnitive Impairment (ARTICO) evaluated with neuropsychological and advanced neuroimaging: a longitudinal cohort study. BMC Neurol 2023; 23:310. [PMID: 37612651 PMCID: PMC10463330 DOI: 10.1186/s12883-023-03362-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Aortic stenosis is the most common valvulopathy in Western countries. The treatment of choice had been surgery aortic valve replacement (SAVR), but the improvement in endovascular approaches as transcatheter aortic valve implantation (TAVI), initially reserved for patients with very high surgical risk, has been extended to high and intermediate, and recently also to low-risk patients. Stroke and vascular cognitive impairment are the most important complications. It is not entirely clear which technique is best to avoid these complications as well as their impact. Our goal is to evaluate changes in cognitive performance in the early (1-month) and late (1-year) postoperative period in patients undergoing SAVR or TAVI, by extensive neuropsychological study (NRP) and advanced Magnetic Resonance Imaging (MRI). Specifically, to compare early and late cognitive changes after the intervention between both groups, the occurrence of stroke during follow-up and to compare the appearance of silent vascular lesions and changes in brain activity and functional connectivity with functional MRI during follow-up between both groups. METHODS/DESIGN Prospective longitudinal cohort study. A non-selected representative sample of 80 subjects, 40 SAVR and 40 TAVI to obtain a final sample of 36 eligible subjects in each group, ranging from 70 to 85 years old, with indication for aortic replacement and intermediate or high surgical risk will be studied. At baseline, within one month before the treatment, all individuals will undergo an extensive NRP and advanced MRI study. These studies will also be performed 1-month and 1-year after treatment, to assess the appearance of new vascular lesions, as well as changes in cognitive performance with respect to baseline. DISCUSSION This study aims to evaluate changes in cognitive performance as well as both clinical and silent vascular events occurring in the early (1-month) and late (1-year) periods after SAVR and TAVI. We will also analyze the correlation between neuropsychological and neuroimaging approaches in order to evaluate cognition. Therefore, it may provide high-quality data of cognitive changes and vascular events for both techniques, and be useful to tailor interventions to individual characteristics and ultimately aiding in decision-making. TRIAL REGISTRATION This study is register in Clinicaltrials.gov (NCT05235529) on 11th February 2022.
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Affiliation(s)
- Meritxell Gomis
- Department of Neurosciences, Servei de Neurologia, Unitat d'Ictus, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain.
| | - Claudio Fernández
- Servei de Cirurgia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Rosalia Dacosta-Aguayo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Mataró, Spain Department of Clinical Psychology and Psychobiology, Institut Germans Trias i Pujol (IGTP) Unitat de Suport a la Recerca Metropolitana Nord, University of Barcelona, Barcelona, Spain
| | - Xavi Carrillo
- Àrea del Cor, Servei de Cardiologia i de la Unitat d'Hemodinàmica i Cardiologia Intervencionista, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Silvia Martínez
- Department of Neurosciences, Servei de Neurologia, Unitat de Neuropsicologia, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Christian Muñoz Guijosa
- Servei de Cirurgia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Elisabet Berastegui
- Servei de Cirurgia Cardíaca, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | | | - Josep Puig
- Centre de Medicina Comparativa i Bioimatge de Catalunya, Institut de Recerca Germans Trias i Pujol, Barcelona, Badalona, Spain
| | - Eva Bernal
- Àrea del Cor, Servei de Cardiologia i de la Unitat d'Hemodinàmica i Cardiologia Intervencionista, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Anna Ramos
- Department of Neurosciences, Servei de Neurologia, Unitat d'Ictus, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
| | - Cynthia Cáceres
- Department of Neurosciences, Servei de Neurologia, Unitat de Neuropsicologia, Hospital Universitari Germans Trias i Pujol, Universitat Auntònoma de Barcelona, Barcelona, Badalona, Spain
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3
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Agasthi P, Ashraf H, Pujari SH, Girardo M, Tseng A, Mookadam F, Venepally N, Buras MR, Abraham B, Khetarpal BK, Allam M, MD SKM, Eleid MF, Greason KL, Beohar N, Sweeney J, Fortuin D, Holmes DRJ, Arsanjani R. Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning. World J Cardiol 2023; 15:95-105. [PMID: 37033682 PMCID: PMC10074998 DOI: 10.4330/wjc.v15.i3.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM.
AIM To apply machine learning to be used to predict pre-procedural risk for PPM.
METHODS A retrospective study of 1200 patients who underwent TAVR (January 2014-December 2017) was performed. 964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis. After the exclusion of variables with near-zero variance or ≥ 50% missing data, 167 variables were included in the random forest gradient boosting algorithm (GBM) optimized using 5-fold cross-validations repeated 10 times. The receiver operator curve (ROC) for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.
RESULTS Of 964 patients included in the 30-d analysis without prior PPM, 19.6% required PPM post-TAVR. The mean age of patients was 80.9 ± 8.7 years. 42.1 % were female. Of 657 patients included in the 1-year analysis, the mean age of the patients was 80.7 ± 8.2. Of those, 42.6% of patients were female and 26.7% required PPM at 1-year post-TAVR. The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model (0.66 and 0.72) was superior to that of the PPM risk score (0.55 and 0.54) with a P value < 0.001.
CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Hasan Ashraf
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Sai Harika Pujari
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Marlene Girardo
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Farouk Mookadam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Nithin Venepally
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Matthew R Buras
- Department of Statistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Bishoy Abraham
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | | | - Mohamed Allam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Siva K Mulpuru MD
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Nirat Beohar
- Mount Sinai Medical Center, Columbia University, Miami Beach, FL 33138, United States
| | - John Sweeney
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David Fortuin
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David R Jr Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
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4
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Ghiasvand H, Khaleghparast S, Kachoueian N, Tirgarfakheri K, Mortazian M, Toloueitabar Y, Gorjipour F, Naghdi S. Transcatheter aortic valve implantation against conventional aortic valve replacement surgery in high-risk patients with aortic stenosis; a cost-effectiveness analysis. HEALTH ECONOMICS REVIEW 2023; 13:1. [PMID: 36595100 PMCID: PMC9808935 DOI: 10.1186/s13561-022-00411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 12/01/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Aortic stenosis is a prevalent heart valvular disorder in Iran. Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) are two common procedures for treating the disease in the current clinical pathway. However, TAVI is an expensive procedure, and for Iran with severe limitations in financial resources, it is crucial to investigate the cost-effectiveness of the technology against other competing alternatives with the same purpose. This study aims to analyse the cost-effectiveness of TAVI vs SAVR in elderly patients who are at a higher risk of surgery. METHODS This study is a decision economic evaluation modeling, with a lifetime horizon and a healthcare payer (health insurer) perspective. The utility values are from a previous study, transitional probabilities come from an established clinical trial called PARTNER-1, and the unit costs are from Iran's national fee schedule for medical services. The probabilistic and one-way sensitivity analyses have been performed to mitigate the uncertainty. RESULTS The incremental cost, effectiveness, and cost-effectiveness ratio for the base case were: 368,180,101 Iranian Rial, (US$ 1,473), 0.37 QALY-per-patient, and, 995,081,354 Iranian Rial (US$ 3,980), respectively. The probabilistic sensitivity analysis yielded 981,765,302 I.R.I Rials (US$ 3,927) per patient for the ICER. The probability of being cost-effective at one and three times the country's Gross Domestic Production (GDP) is 0.31 and 0.83, respectively. CONCLUSIONS TAVI does not seem a cost-effective procedure in comparison with SAVR at the current willingness to pay thresholds of the country. However, by increasing the WTP threshold to 3 times the GDP per capita the probability of being cost-effective will raise to 83%.
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Affiliation(s)
- Hesam Ghiasvand
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Shiva Khaleghparast
- Cardiovascular Nursing Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Naser Kachoueian
- Department of Cardiac Surgery, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kourosh Tirgarfakheri
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Mortazian
- AJA University of Medical Sciences Tehran Iran AJA University of Medical Sciences, Tehran, Iran
| | - Yaser Toloueitabar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farhad Gorjipour
- Iranian Scientific Society of Extracorporeal Technology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyran Naghdi
- National Center for Health Insurance Research, Tehran, Iran
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5
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Torky MA, Arafat AA, Fawzy HF, Taha AM, Wahby EA, Herijgers P. J-ministernotomy for aortic valve replacement: a retrospective cohort study. THE CARDIOTHORACIC SURGEON 2021. [DOI: 10.1186/s43057-021-00050-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The advantage of minimally invasive sternotomy (MS) over full sternotomy (FS) for isolated aortic valve replacement (AVR) is still controversial. We aimed to examine if J-shaped MS is a safe alternative to FS in patients undergoing primary isolated AVR. This study is a retrospective and restricted cohort study that included 137 patients who had primary isolated AVR from February 2013 to June 2015. Patients with previous cardiac operations, low ejection fraction (< 40%), infective endocarditis, EuroSCORE II predicted mortality > 10%, and patients who had inverted T or inverted C-MS or right anterior thoracotomy were excluded. Patients were grouped into the FS group (n=65) and MS group (n=72). Preoperative variables were comparable in both groups. The outcome was studied, balancing the groups by propensity score matching.
Results
Seven (9%) patients in the MS group were converted to FS. Cardiopulmonary bypass (98.5 ± 29.3 vs. 82.1 ± 13.95 min; p ≤ 0.001) and ischemic times (69.1 ± 23.8 vs. 59.6 ± 12.2 min; p = 0.001) were longer in MS. The MS group had a shorter duration of mechanical ventilation (10.1 ± 11.58 vs. 10.9 ± 6.43 h; p = 0.045), ICU stay (42.74 ± 40.5 vs. 44.9 ± 39.3; p = 0.01), less chest tube drainage (385.3 ± 248.6 vs. 635.9 ± 409.6 ml; p = 0.001), and lower narcotics use (25.14 ± 17.84 vs. 48.23 ± 125.68 mg; p < 0.001). No difference was found in postoperative heart block with permanent pacemaker insertion or atrial fibrillation between groups (p = 0.16 and 0.226, respectively). Stroke, renal failure, and mortality did not differ between the groups. Reintervention-free survival at 1, 3, and 4 years was not significantly different in both groups (p = 0.73).
Conclusion
J-ministernotomy could be a safe alternative to FS in isolated primary AVR. Besides the cosmetic advantage, it could have better clinical outcomes without added risk.
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6
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Krasniqi L, Kronby MP, Riber LPS. Long-term survival after Carpentier-Edwards Perimount aortic valve replacement in Western Denmark: a multi-centre observational study. J Cardiothorac Surg 2021; 16:130. [PMID: 33990211 PMCID: PMC8120717 DOI: 10.1186/s13019-021-01506-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study describes the long-term survival, risk of reoperation and clinical outcomes of patients undergoing solitary surgical aortic valve replacement (SAVR) with a Carpentier-Edwards Perimount (CE-P) bioprosthetic in Western Denmark. The renewed interest in SAVR is based on the questioning regarding the long-term survival since new aortic replacement technique such as transcatheter aortic-valve replacement (TAVR) probably have shorter durability, why assessment of long-term survival could be a key issue for patients. Methods From November 1999 to November 2013 a cohort of a total of 1604 patients with a median age of 73 years (IQR: 69–78) undergoing solitary SAVR with CE-P in Western Denmark was obtained November 2018 from the Western Danish Heart Registry (WDHR). The primary endpoint was long-term survival from all-cause mortality. Secondary endpoints were survival free from major adverse cardiovascular and cerebral events (MACCE), risk of reoperation, cause of late death, patient-prothesis mismatch, risk of AMI, stroke, pacemaker or ICD implantation and postoperative atrial fibrillation (POAF). Time-to-event analysis was performed with Kaplan-Meier curve, cumulative incidence function was performed with Nelson-Aalen cumulative hazard estimates. Cox regression was applied to detect risk factors for death and reoperation. Results In-hospital mortality was 2.7% and 30-day mortality at 3.4%. The 5-, 10- and 15-year survival from all-cause mortality was 77, 52 and 24%, respectively. Survival without MACCE was 80% after 10 years. Significant risk factors of mortality were small valves, smoking and EuroSCORE II ≥4%. The risk of reoperation was < 5% after 7.5 years and significant risk factors were valve prosthesis-patient mismatch and EuroSCORE II ≥4%. Conclusions Patients undergoing aortic valve replacement with a Carpentier-Edwards Perimount valve shows a very satisfying long-term survival. Future research should aim to investigate biological valves long-term durability for comparison of different SAVR to different TAVR in long perspective.
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Affiliation(s)
- Lytfi Krasniqi
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark. .,Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Mads P Kronby
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
| | - Lars P S Riber
- Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Faculty of Health Science, University of Southern Denmark, Odense, Denmark
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7
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Kutlubaev MA, Nikolaeva IE, Oleinik BA, Kutlubaeva RF. [Perioperative strokes in cardiac surgery]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:10-15. [PMID: 33908226 DOI: 10.17116/jnevro202112103210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The frequency of perioperative stroke in cardiosurgical practice may reach up to 10%. The risk of stroke is especially high after coronary artery bypass surgery and valve replacement. Perioperative stroke is related to embolism with the fragments of atherosclerotic plaque, arterial hypotension, cardiac arrhythmias, hypercoagulation, etc. The likelihood of stroke can be reduced by preoperative assessment of the patient. It is important to control blood pressure and saturation during the surgery. The manipulation on aorta should be minimized in order to reduce the risk of perioperative stroke. Important role belongs to timely identification of those who developed stroke after surgery. The only possible method of reperfusion therapy in perioperative stroke is mechanical thrombectomy.
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Affiliation(s)
| | - I E Nikolaeva
- Bashkir State Medical University, Ufa, Russia.,Republican Cardiological Center, Ufa, Russia
| | - B A Oleinik
- Bashkir State Medical University, Ufa, Russia.,Republican Cardiological Center, Ufa, Russia
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8
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Moss S, Doyle M, Nagaraja V, Peeceeyen S. A systematic review and meta-analysis of the clinical outcomes of TAVI versus SAVR in the octogenarian population. Indian J Thorac Cardiovasc Surg 2020; 36:356-364. [PMID: 33061143 DOI: 10.1007/s12055-019-00912-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 12/15/2022] Open
Abstract
Background Surgical aortic valve replacement (SAVR) has shown safe, robust results in elderly populations, and up until recently, was the gold standard for management of severe aortic stenosis. The approach to severe aortic stenosis in high-risk populations, such as octogenarians, has been challenged with the development of transcatheter-based strategies. We sought to systematically analyse outcomes between surgical and transcatheter aortic valve replacement (TAVI) in octogenarians. Method Electronic databases were searched from their inception until November 2018 for studies comparing SAVR to TAVI in octogenarians, according to a predefined search criterion. The primary end point was mortality, and secondary end points included post-procedural complications. Results The review yielded four observational studies. The total number of patients included was 1221 including 395 who underwent TAVI and 826 SAVR. On average, patients from both subgroups carried a high number of cardiac risk factors, and STS-PROM scoring yielded mean values equating to high-risk population groups, with significantly higher values for TAVI patients across the board. The presence of post-procedural moderate aortic regurgitation was noted only in the TAVI population (OR = 8.88; 95% CI (1.47-53.64), χ2 = 1.22; p = 0.02; I 2 = 0%). Otherwise, there were no significant differences when accounting for mortality (OR = 0.68; 95% CI (0.44-1.05), χ2 = 1.88; p = 0.60; I 2 = 0%), permanent pacemaker implantation groups (OR = 0.45; 95% CI (0.44-1.49), χ2 = 0.11; p = 0.19; I 2 = 0%), and neurological events (OR = 0.72; 95% CI (0.42-1.23), χ2 = 2.57; p = 0.23; I 2 = 22%). Discussion The analysed data on TAVI versus SAVR in the octogenarian population show that TAVI shows similar outcomes with relation to mortality and inpatient admission times, in a population with significantly higher risk profiles than their SAVR counterparts. TAVI has higher occurrences of post-procedural AR. TAVI still does not have robust long-term data to ensure its efficacy and rate of complications, but is showing promising results nonetheless.
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Affiliation(s)
- Stuart Moss
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
| | - Mathew Doyle
- Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050 Australia
| | - Vinayak Nagaraja
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
| | - Sheen Peeceeyen
- St George Hospital, 1 Grey St, Kogarah, New South Wales 2217 Australia
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9
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Wang H, Song H, Yang Y, Cao Q, Hu Y, Chen J, Guo J, Wang Y, Jia D, Cao S, Zhou Q. Three-dimensional printing for cardiovascular diseases: from anatomical modeling to dynamic functionality. Biomed Eng Online 2020; 19:76. [PMID: 33028306 PMCID: PMC7542711 DOI: 10.1186/s12938-020-00822-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/28/2020] [Indexed: 12/16/2022] Open
Abstract
Three-dimensional (3D) printing is widely used in medicine. Most research remains focused on forming rigid anatomical models, but moving from static models to dynamic functionality could greatly aid preoperative surgical planning. This work reviews literature on dynamic 3D heart models made of flexible materials for use with a mock circulatory system. Such models allow simulation of surgical procedures under mock physiological conditions, and are; therefore, potentially very useful to clinical practice. For example, anatomical models of mitral regurgitation could provide a better display of lesion area, while dynamic 3D models could further simulate in vitro hemodynamics. Dynamic 3D models could also be used in setting standards for certain parameters for function evaluation, such as flow reserve fraction in coronary heart disease. As a bridge between medical image and clinical aid, 3D printing is now gradually changing the traditional pattern of diagnosis and treatment.
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Affiliation(s)
- Hao Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Hongning Song
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yuanting Yang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Quan Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yugang Hu
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Jinling Chen
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Juan Guo
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yijia Wang
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Dan Jia
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Sheng Cao
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
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10
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Williams ML, Flynn CD, Mamo AA, Tian DH, Kappert U, Wilbring M, Folliguet T, Fiore A, Miceli A, D'Onofrio A, Cibin G, Gerosa G, Glauber M, Fischlein T, Pollari F. Long-term outcomes of sutureless and rapid-deployment aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2020; 9:265-279. [PMID: 32832408 DOI: 10.21037/acs-2020-surd-25] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Sutureless and rapid-deployment aortic valve replacement (SURD-AVR) has become a prominent area of research as the medical community evaluate its place amongst other aortic valve interventions. The main advantages of SURD-AVR established to date are the reduced cross-clamp and cardiopulmonary bypass (CPB) times, as well as facilitating minimally invasive surgery in high-risk surgical patients. This current systematic review and meta-analysis, to our knowledge, is the first focusing on long-term outcomes regarding safety, efficacy and durability of SURD-AVR from available current literature. Methods A literature search via six electronic databases was performed from their inception to November 2019. Inclusion criteria for this systematic review included survival and postoperative echocardiographic outcomes greater than five years in patients who underwent SURD-AVR with either Perceval or Intuity valves. Studies were identified and data extracted by two independent reviewers. Long-term survival outcomes were aggregated using digitized Kaplan-Meier curves where available. Results After applying predefined inclusion and exclusion criteria, four studies were identified for review. All four studies were observational and in total reported data for 1,998 patients. Almost half (42.4%) of patients underwent SURD-AVR via full sternotomy, with almost one third (30.1%) also undergoing concomitant cardiac procedures. Aggregate overall survival rates at 1-, 2-, 3-, and 5-year follow-up were 94.9%, 91.2%, 89.0%, and 84.2%, respectively. Incidence of strokes (4.8%), severe paravalvular leaks (PVLs) (1.5%) and permanent pacemaker (PPM) insertion (8.2%) at up to 5-year follow-up were acceptable. At 5-year follow-up hemodynamic outcomes were also acceptable for mean pressure gradient (MPG) (range, 8.8-13.6 mmHg), peak pressure gradient (PPG) (range, 18.9-21.1 mmHg) and effective orifice area (EOA) (range, 1.5-1.8 cm2). Conclusions Evaluation of the evidence reporting long-term outcomes of SURD-AVR suggests that it is a safe procedure for AVR with low rates of complications. Long-term outcomes presented in this review show that not only does SURD-AVR have acceptable survival rates, but also good hemodynamic performance at 5-year follow-up.
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Affiliation(s)
- Michael L Williams
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,The University of Sydney, Sydney, Australia
| | - Campbell D Flynn
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Cardiothoracic Surgery, Epworth Hospital, Richmond, Melbourne, Australia
| | - Andrew A Mamo
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - David H Tian
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Sydney, Australia
| | - Utz Kappert
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Manuel Wilbring
- Department of Cardiac Surgery, University Heart Center Dresden, Dresden, Germany
| | - Thierry Folliguet
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Fiore
- Department of Cardiac Surgery, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Antonio Miceli
- Minimally Invasive Cardiac Surgery, Istituto Clinico Sant'Ambrogio, Milano, Italy
| | | | - Giorgia Cibin
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, University of Padova, Padova, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio - Gruppo San Donato, Milano, Italy
| | - Theodor Fischlein
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
| | - Francesco Pollari
- Cardiac Surgery, Paracelsus Medical University - Klinikum Nürnberg, Nuremberg, Germany
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11
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A validated computational framework to predict outcomes in TAVI. Sci Rep 2020; 10:9906. [PMID: 32555300 PMCID: PMC7303192 DOI: 10.1038/s41598-020-66899-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/28/2020] [Indexed: 11/08/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) still presents complications: paravalvular leakage (PVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patient-specific implantation sites. The procedures were simulated with finite element analysis. Simulations' results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. This study suggests that computational tool could support safe planning and broadening of TAVI.
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12
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Abstract
Heart valve diseases are common disorders with five million annual diagnoses being made in the United States alone. All heart valve disorders alter cardiac hemodynamic performance; therefore, treatments aim to restore normal flow. This paper reviews the state-of-the-art clinical and engineering advancements in heart valve treatments with a focus on hemodynamics. We review engineering studies and clinical literature on the experience with devices for aortic valve treatment, as well as the latest advancements in mitral valve treatments and the pulmonic and tricuspid valves on the right side of the heart. Upcoming innovations will potentially revolutionize treatment of heart valve disorders. These advancements, and more gradual enhancements in the procedural techniques and imaging modalities, could improve the quality of life of patients suffering from valvular disease who currently cannot be treated.
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Affiliation(s)
- Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv Israel
- To whom correspondence should be addressed. E-mail:
| | - Shmuel Einav
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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13
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Abstract
PURPOSE OF REVIEW This review overviews perioperative stroke as it pertains to specific surgical procedures. RECENT FINDINGS As awareness of perioperative stroke increases, so does the opportunity to potentially improve outcomes for these patients by early stroke recognition and intervention. Perioperative stroke is defined to be any stroke that occurs within 30 days of the initial surgical procedure. The incidence of perioperative stroke varies and is dependent on the specific type of surgery performed. This chapter overviews the risks, mechanisms, and acute evaluation and management of perioperative stroke in four surgical populations: cardiac surgery, carotid endarterectomy, neurosurgery, and non-cardiac/non-carotid/non-neurological surgeries.
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Affiliation(s)
- Megan C Leary
- Department of Neurology, Lehigh Valley Hospital and Health Network, 1250 S Cedar Crest Blvd, Suite 405, Allentown, PA, 18103-6224, USA. .,Morsani College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Preet Varade
- Department of Neurology, Lehigh Valley Hospital and Health Network, 1250 S Cedar Crest Blvd, Suite 405, Allentown, PA, 18103-6224, USA.,Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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14
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Wagner G, Steiner S, Gartlehner G, Arfsten H, Wildner B, Mayr H, Moertl D. Comparison of transcatheter aortic valve implantation with other approaches to treat aortic valve stenosis: a systematic review and meta-analysis. Syst Rev 2019; 8:44. [PMID: 30722786 PMCID: PMC6362570 DOI: 10.1186/s13643-019-0954-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/18/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVI) is an alternative treatment for patients with symptomatic severe aortic stenosis ineligible for surgical aortic valve replacement (SAVR) or at increased perioperative risk. Due to continually emerging evidence, we performed a systematic review and meta-analysis comparing benefits and harms of TAVI, SAVR, medical therapy, and balloon aortic valvuloplasty. METHODS We searched MEDLINE, Embase, and Cochrane CENTRAL from 2002 to June 6, 2017. We dually screened abstracts and full-text articles for randomized controlled trials (RCTs) and propensity score-matched observational studies. Two investigators independently rated the risk of bias of included studies and determined the certainty of evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation). If data permitted, we performed meta-analyses using random- and fixed-effects models. RESULTS Out of 7755 citations, we included six RCTs (5862 patients) and 13 observational studies (6376 patients). In meta-analyses, patients treated with SAVR or TAVI had similar risks for mortality at 30 days (relative risk [RR] 1.05; 95% confidence interval [CI] 0.82 to 1.33) and 1 year (RR 1.02; 95% CI 0.93 to 1.13). TAVI had significantly lower risks for major bleeding but increased risks for major vascular complications, moderate or severe paravalvular aortic regurgitation, and new pacemaker implantation compared to SAVR. Comparing TAVI to medical therapy, mortality did not differ at 30 days but was significantly reduced at 1 year (RR 0.51; 95% CI 0.34 to 0.77). CONCLUSIONS Given similar mortality risks but different patterns of adverse events, the choice between TAVI and SAVR remains an individual one.
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Affiliation(s)
- Gernot Wagner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
| | - Sabine Steiner
- Division of Interventional Angiology, University Hospital Leipzig, Liebigstraße 20, Haus 4, 04103 Leipzig, Germany
| | - Gerald Gartlehner
- Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Dr.-Karl-Dorrek-Straße 30, 3500 Krems, Austria
- RTI International, 3040 East Cornwallis Road, PO Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Henrike Arfsten
- Department of Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Brigitte Wildner
- University Library-Information Retrieval Office, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Harald Mayr
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Dunant-Platz 1, 3100 St. Poelten, Austria
| | - Deddo Moertl
- Department of Internal Medicine 3, University Hospital St. Poelten, Karl Landsteiner University of Health Sciences, Dunant-Platz 1, 3100 St. Poelten, Austria
- Institute for Research of Ischaemic Cardiac Disease and Rhythmology, Karl Landsteiner Society, Dunant-Platz 1, 3100 St. Poelten, Austria
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15
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Rotman OM, Bianchi M, Ghosh RP, Kovarovic B, Bluestein D. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices 2018; 15:771-791. [PMID: 30318937 PMCID: PMC6417919 DOI: 10.1080/17434440.2018.1536427] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. AREAS COVERED Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices. We further review in detail some of the up-to-date modeling and testing approaches for TAVR, both computationally and experimentally, and additionally discuss those as complementary approaches to the ISO 5840-3 standard. A comprehensive survey of the prior and up-to-date literature was conducted to cover the most pertaining issues and challenges that TAVR technology faces. EXPERT COMMENTARY The expansion of TAVR over SAVR and to new indications seems more promising than ever. With new challenges to come, new TAV design approaches, and materials used, are expected to emerge, and novel testing/modeling methods to be developed.
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Affiliation(s)
- Oren M. Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Ram P. Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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16
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Thitivaraporn P, Chiramongkol S, Muntham D, Pornpatrtanarak N, Kittayarak C, Namchaisiri J, Singhatanadgige S, Ongcharit P, Benjacholamas V. Thrombocytopenia in Moderate- to High-Risk Sutureless Aortic Valve Replacement. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:172-179. [PMID: 29854661 PMCID: PMC5973213 DOI: 10.5090/kjtcs.2018.51.3.172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 02/02/2018] [Accepted: 02/07/2018] [Indexed: 11/16/2022]
Abstract
Background This study aimed to compare preliminary data on the outcomes of sutureless aortic valve replacement (SU-AVR) with those of aortic valve replacement (AVR). Methods We conducted a retrospective study of SU-AVR in moderate- to high-risk patients from 2013 to 2016. Matching was performed at a 1:1 ratio using the Society of Thoracic Surgeons predicted risk of mortality score with sex and age. The primary outcome was 30-day mortality. The secondary outcomes were operative outcomes and complications. Results A total of 277 patients were studied. Ten patients (50% males; median age, 81.5 years) underwent SU-AVR. Postoperative echocardiography showed impressive outcomes in the SU-AVR group. The 30-day mortality was 10% in both groups. In our study, the patients in the SU-AVR group developed postoperative thrombocytopenia. Platelet counts decreased from 225×103/μL preoperatively to 94.5, 54.5, and 50.1×103/μL on postoperative days 1, 2, and 3, respectively, showing significant differences compared with the AVR group (p=0.04, p=0.16, and p=0.20, respectively). The median amount of platelet transfusion was higher in the AVR group (12.5 vs. 0 units, p=0.052). Conclusion There was no difference in the 30-day mortality of moderate- to high-risk patients depending on whether they underwent SU-AVR or AVR. Although SU-AVR is associated with favorable cardiopulmonary bypass and cross-clamp times, it may be associated with postoperative thrombocytopenia.
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Affiliation(s)
| | - Sarun Chiramongkol
- Cardiovascular and Thoracic Surgery Unit, King Chulalongkorn Memorial Hospital
| | - Dittapol Muntham
- Section of Mathematic, Faculty of Science and Technology, Rajamangala University of Technology Suvarnabhumi
| | | | | | - Jule Namchaisiri
- Cardiovascular and Thoracic Surgery Unit, King Chulalongkorn Memorial Hospital
| | | | - Pat Ongcharit
- Cardiovascular and Thoracic Surgery Unit, King Chulalongkorn Memorial Hospital
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17
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Vejpongsa P, Zhang X, Bhise V, Kitkungvan D, Shivamurthy P, Anderson HV, Balan P, Nguyen TC, Estrera AL, Dougherty AH, Smalling RW, Dhoble A. Risk Prediction Model for Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2018. [DOI: 10.1080/24748706.2018.1467067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Pimprapa Vejpongsa
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Xu Zhang
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas McGovern Medical School at Houston, Houston, Texas, USA
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Viraj Bhise
- University of Texas McGovern Medical School, Houston, Texas, USA
- School of Public Health, University of Texas, Houston, Texas, USA
| | - Danai Kitkungvan
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Poojita Shivamurthy
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - H. Vernon Anderson
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Prakash Balan
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Tom C. Nguyen
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Anthony L. Estrera
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Anne H. Dougherty
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Richard W. Smalling
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
| | - Abhijeet Dhoble
- University of Texas McGovern Medical School, Houston, Texas, USA
- Memorial Herman Heart and Vascular Center, Texas Medical Center, Houston, Texas, USA
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18
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Barth A, Yücel S, Ince H, Doblhammer G. Impact of transcatheter aortic valve implantation on the risk of mortality in patients with severe aortic valve diseases: a health insurance-based analysis. Open Heart 2018; 5:e000756. [PMID: 29713484 PMCID: PMC5922570 DOI: 10.1136/openhrt-2017-000756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/07/2018] [Accepted: 03/21/2018] [Indexed: 01/25/2023] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for aortic valve patients who are inoperable or have a prohibitively high surgical risk for surgical aortic valve replacement (SAVR). Most studies compare the efficacy of TAVI and SAVR, yet the assessment of TAVI for this group of patients requires more study. Methods This quasiexperimental study compares TAVI cases (ages of 75–90 years, n=187) ex-post with a control group without implantation (n=728, 4:1 ratio intended). The control group was drawn randomly on the condition that it matches the TAVI cases based on age at aortic valve disease incidence, gender and comorbidity index. The mortality risk is analysed from incident diagnosis. Data were taken from three random samples of health claims data in Germany’s largest public health insurance (Allgemeine Ortskrankenkassen) and cover the years 2004–2013 (n=750 000). Results Compared with the medically treated control group with 6+ comorbidities, medically treated patients with fewer comorbidities have half the mortality risk (HR 0.48, 95% CI 0.34 to 0.69, p<0.001). TAVI patients with fewer than six comorbidities show a mortality risk half that (HR 0.23, 95% CI 0.09 to 0.63, p=0.004). TAVI patients with 6+ comorbidities do not benefit from TAVI compared with the control group with 6+ comorbidities (HR 0.99, 95% CI 0.71 to 1.36, p=0.93). Conclusion TAVI is an effective therapy for aortic valve disease patients with few comorbidities; it is not effective for patients with a high comorbidity burden. Careful assessment of the individual patient in terms of comorbidities is important for a beneficial outcome.
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Affiliation(s)
- Alexander Barth
- Institute of Sociology and Demography, University of Rostock, Rostock, Germany.,Rostock Center for the Study of Demographic Change, University of Rostock, Rostock, Germany
| | - Seyrani Yücel
- Divison of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Hüseyin Ince
- Divison of Cardiology, University Hospital Rostock, Rostock, Germany
| | - Gabriele Doblhammer
- Institute of Sociology and Demography, University of Rostock, Rostock, Germany.,Rostock Center for the Study of Demographic Change, University of Rostock, Rostock, Germany
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19
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Rotman OM, Kovarovic B, Sadasivan C, Gruberg L, Lieber BB, Bluestein D. Realistic Vascular Replicator for TAVR Procedures. Cardiovasc Eng Technol 2018; 9:339-350. [PMID: 29654509 DOI: 10.1007/s13239-018-0356-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 04/07/2018] [Indexed: 10/17/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is an over-the-wire procedure for treatment of severe aortic stenosis (AS). TAVR valves are conventionally tested using simplified left heart simulators (LHS). While those provide baseline performance reliably, their aortic root geometries are far from the anatomical in situ configuration, often overestimating the valves' performance. We report on a novel benchtop patient-specific arterial replicator designed for testing TAVR and training interventional cardiologists in the procedure. The Replicator is an accurate model of the human upper body vasculature for training physicians in percutaneous interventions. It comprises of fully-automated Windkessel mechanism to recreate physiological flow conditions. Calcified aortic valve models were fabricated and incorporated into the Replicator, then tested for performing TAVR procedure by an experienced cardiologist using the Inovare valve. EOA, pressures, and angiograms were monitored pre- and post-TAVR. A St. Jude mechanical valve was tested as a reference that is less affected by the AS anatomy. Results in the Replicator of both valves were compared to the performance in a commercial ISO-compliant LHS. The AS anatomy in the Replicator resulted in a significant decrease of the TAVR valve performance relative to the simplified LHS, with EOA and transvalvular pressures comparable to clinical data. Minor change was seen in the mechanical valve performance. The Replicator showed to be an effective platform for TAVR testing. Unlike a simplified geometric anatomy LHS, it conservatively provides clinically-relevant outcomes and complement it. The Replicator can be most valuable for testing new valves under challenging patient anatomies, physicians training, and procedural planning.
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Affiliation(s)
- Oren M Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Chander Sadasivan
- Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, 11794, USA.,Vascular Simulations LLC, Stony Brook, NY, 11790, USA
| | | | - Baruch B Lieber
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.,Department of Neurological Surgery, Stony Brook University, Stony Brook, NY, 11794, USA.,Vascular Simulations LLC, Stony Brook, NY, 11790, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.
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20
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Olsson K, Näslund U, Nilsson J, Hörnsten Å. Patients' experiences of the transcatheter aortic valve implantation trajectory: A grounded theory study. Nurs Open 2018; 5:149-157. [PMID: 29599990 PMCID: PMC5867280 DOI: 10.1002/nop2.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022] Open
Abstract
Aim The aim of this study was to explore how patients experienced the recovery process from transcatheter aortic valve implantation. Design A qualitative approach where in-depth interviews were used. Method Eleven men and eight women undergoing transcatheter aortic valve implantation were individually interviewed 6 months after transcatheter aortic valve implantation. Grounded theory was used for the analysis. Results The analysis generated the core concept "A journey of balancing between life-struggle and hope" connected to descriptive, bipolar categories. Before transcatheter aortic valve implantation patients not only felt threatened but also experienced hope. The rehabilitation phase was described as demanding or surprisingly simple. At the 6 months follow-up patients were pleased to return to life, however, still struggling with limitations. To feel hope is essential for transcatheter aortic valve implantation patients' well-being, both before and during the recovery process. It is important that healthcare professionals not only support hopeful thinking but also take time to discuss and prepare patients, talk about concerns and build confidence. Individual plans for rehabilitation should be designed.
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Affiliation(s)
- Karin Olsson
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
- Department of NursingUmeå UniversityUmeaSweden
| | - Ulf Näslund
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
| | - Johan Nilsson
- Cardiology, Heart CentreDepartment of Public Health and Clinical MedicineUmeå UniversityUmeaSweden
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21
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Itchhaporia D. Transcatheter aortic valve replacement in women. Clin Cardiol 2018; 41:228-231. [PMID: 29485678 DOI: 10.1002/clc.22912] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 01/23/2018] [Accepted: 01/30/2018] [Indexed: 11/07/2022] Open
Abstract
This review examines the treatment options for women with severe aortic stenosis. It is known that female sex is associated with poorer outcomes after surgical aortic valve replacement. With the introduction and adoption of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement, there are emerging data about the potential impact of female sex-specific characteristics on clinical outcomes after transcatheter aortic valve replacement. These data provide an insight into female-specific aspects of the treatment of aortic stenosis. The data can help guide patient selection, choice of intervention method, and evaluation of risk to help improve long-term follow-up of patients with aortic stenosis.
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Affiliation(s)
- Dipti Itchhaporia
- Robert and Georgia Roth Endowed Chair for Excellence in Cardiac Care, Director of Disease Management, Jeffrey M. Carlton Heart and Vascular Institute, Hoag Memorial Hospital Presbyterian, California
- Assistant Clinical Professor, School of Medicine, University of California, Irvine
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Hoffmann CT, Heiner JA, Nguyen TC. Review of minimal access versus transcatheter aortic valve replacement for patients with severe aortic stenosis. Ann Cardiothorac Surg 2017; 6:498-503. [PMID: 29062745 PMCID: PMC5639223 DOI: 10.21037/acs.2017.09.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/30/2017] [Indexed: 11/06/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) and minimally invasive aortic valve replacement (miniAVR) have become alternatives to surgical aortic valve replacement via median sternotomy (SAVR) to treat severe aortic stenosis (AS). Despite increased interest and utilization, few studies have directly compared TAVR and miniAVR. A review of the current literature shows TAVR to be an indispensable tool for inoperable, high-risk, and perhaps intermediate-risk patients with severe AS. However, it is associated with a number of deleterious perioperative outcomes, such as valvular regurgitation and vascular complications. MiniAVR is associated with decreased intensive care unit (ICU) and hospital length of stay, a lower incidence of blood transfusions, decreased ventilation time, and improved cosmetic results. MiniAVR maintains potential advantages over SAVR, including the implantation of a durable prosthesis and low rates of perioperative myocardial infarction and paravalvular leak. It is associated with longer aortic cross clamp and cardiopulmonary bypass (CPB) times; however, the use of sutureless valve implants can circumvent this. Studies comparing TAVR and miniAVR demonstrate decreased postoperative mortality, valvular regurgitation, and incidence of stroke in the miniAVR cohorts. Few studies currently exist comparing TAVR and miniAVR, as it is hard to compare the typically low-risk miniAVR versus high-risk TAVR patient populations. It is clear that both strategies will be cornerstones in the modern AVR era, but the situations in which to apply each strategy have not yet been clearly delineated. This highlights the need for surgeons to adopt these minimally invasive techniques. We believe there is a compelling role for miniAVR in low- and intermediate-risk patients, but due to the paucity of data, neither TAVR nor miniAVR should be discounted before a randomized, risk-stratified trial is performed. More studies are needed to compare TAVR and miniAVR in low- and intermediate-risk patients.
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Affiliation(s)
- Carson T Hoffmann
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas at Houston, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Texas, USA
| | - Jacob A Heiner
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas at Houston, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Texas, USA
| | - Tom C Nguyen
- Department of Cardiothoracic and Vascular Surgery, McGovern Medical School, University of Texas at Houston, Memorial Hermann Hospital-Heart and Vascular Institute, Houston, Texas, USA
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Paim L, Fonseca JHPD, Arruda FVD, Gutierrez PS, Moreira LFP, Jatene FB. A New Experimental Device for Transapical Access of the Aortic and Mitral Valves as well as the Aorta in its Various Segments. Braz J Cardiovasc Surg 2017; 32:156-161. [PMID: 28832792 PMCID: PMC5570386 DOI: 10.21470/1678-9741-2017-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 11/26/2022] Open
Abstract
Objective To present the results of a new experimental device developed to facilitate
the transapical access in endovascular treatment of structural heart
diseases. It aims to reduce the risk of bleeding and complications in this
type of access and demonstrate the device as a safe, fast and effective
alternative. Methods CorPoint is composed of three parts: introducer, base with coiled spring, and
closing capsule. By rotating movements, the spring is introduced into the
myocardium and progressively approaches the base to the surface of the
heart. Guidewires and catheters are inserted through the hollow central part
and, at the end of the procedure, the capsule is screwed over the base,
therefore stopping any bleeding. Results The device was implanted in 15 pigs, weighing 60 kg each, through an
anterolateral thoracotomy, while catheters were introduced and guided by
fluoroscopy. All animals had minimal bleeding; introducers with diameter up
to 22 Fr were used and various catheters and guidewires were easily handled.
After finishing the procedure, the closing capsule was attached and no
bleeding was observed at the site. Conclusion This new device has proved effective, fast and secure for the transapical
access. This shows great potential for use, especially by ensuring an easier
and direct access to the mitral and aortic valves; the shortest distance to
be traveled by catheters; access to the ascending and descending aorta;
decreased bleeding complications; decreased surgical time; and the
possibility of allowing the technique to evolve and become totally
percutaneous.
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Affiliation(s)
- Leonardo Paim
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - José Honório Palma da Fonseca
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Francismar Vidal de Arruda
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Paulo Sampaio Gutierrez
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Luiz Felipe Pinho Moreira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
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Patris V, Giakoumidakis K, Argiriou M, Naka KK, Apostolakis E, Field M, Kuduvalli M, Oo A, Siminelakis S. Predictors of length of stay and duration of tracheal intubation after transcatheter aortic valve implantation. J Thorac Dis 2017; 9:1012-1022. [PMID: 28523156 DOI: 10.21037/jtd.2017.03.150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND While short-term outcomes for patients undergoing transcatheter aortic valve implantation (TAVI) have long been studied, there is very little data on their predictors. We aimed to identify the predictors of outcomes, such as intensive care unit (ICU) and in-hospital length of stay (LOS), duration of postoperative intubation and in-hospital mortality, after TAVI procedures. METHODS We conducted a retrospective cohort study of 162 consecutive patients with aortic valve disease, who were admitted to a tertiary hospital of Liverpool for TAVI, during a five-year period. The data was collected using of the hospital's structured database on November 2014. RESULTS By using a multivariate analysis we found that any postoperative bleeding [odds ratio (OR) 2.71; 95% confidence interval (CI): 1.41-5.24] was the independent predictor of prolonged ICU-LOS, while older age (OR 1.11; 95% CI: 1.05-1.17) and transapical TAVI (OR 4.11; 95% CI: 1.94-8.71) were the predictors of prolonged in-hospital LOS. Additionally, patients treated with oral inotropic agents, preoperatively (OR 5.77; 95% CI: 2.21-15.01), non-diabetics (OR 3.07; 95% CI: 1.12-8.42) and those with any postoperative bleeding (OR 3.53; 95% CI: 1.68-7.43) had a significantly greater probability in remaining intubated postoperatively. The multivariate analysis did not reveal any predictor of in-hospital mortality. CONCLUSIONS The above predictors permit the early identification of TAVI patients at high risk for longer hospitalization and increased mechanical ventilation. This piece of information is crucial for clinicians and administrators contributing to more efficient patient care planning and better allocation of healthcare resources.
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Affiliation(s)
- Vasileios Patris
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | | | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Efstratios Apostolakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
| | - Mark Field
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, Heart and Chest Hospital, Thomas Drive, Liverpool, UK
| | - Stavros Siminelakis
- Department of Cardiothoracic Surgery, Medical School, University of Ioannina, Ioannina, Greece
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25
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Ak A, Porokhovnikov I, Kuethe F, Schulze PC, Noutsias M, Schlattmann P. Transcatheter vs. surgical aortic valve replacement and medical treatment : Systematic review and meta-analysis of randomized and non-randomized trials. Herz 2017; 43:325-337. [PMID: 28451702 DOI: 10.1007/s00059-017-4562-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as the procedure of choice for patients with severe aortic stenosis (AS) and high perioperative risk. We performed a meta-analysis to compare the mortality related to TAVR with medical therapy (MT) and surgical aortic valve replacement (SAVR). METHODS A systematic literature search was conducted by two independent investigators from the database inception to 30 December 2014. Relative risk (RR) and odds ratio (OR) were calculated and graphically displayed in forest plots. We used I 2 for heterogeneity (meta-regression) and Egger's regression test of asymmetry (funnel plots). RESULTS We included 24 studies (n = 19 observational studies; n = 5 randomized controlled trials), with a total of 7356 patients in this meta-analysis. Mean age had a substantial negative impact on the long-term survival of AS patients (OR = 1.544; 95% CI: 1.25-1.90). Compared with MT, TAVR showed a statistically significant benefit for all-cause mortality at 12 months (OR = 0.68; 95% CI: 0.49-0.95). Both TAVR and SAVR were associated with better outcomes compared with MT. TAVR showed lower all-cause mortality over SAVR at 12 months (OR = 0.81; 95% CI: 0.68-0.97). The comparison between SAVR and TAVR at 2 years revealed no significant difference (OR = 1.09; 95% CI: 1.01-1.17). CONCLUSION In AS, both TAVR and SAVR provide a superior prognosis to MT and, therefore, MT is not the preferred treatment option for AS. Furthermore, our data show that TAVR is associated with lower mortality at 12 months compared with SAVR. Further studies are warranted to compare the long-term outcome of TAVR versus SAVR beyond a 2-year follow-up period.
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Affiliation(s)
- A Ak
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany
| | - I Porokhovnikov
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany
| | - F Kuethe
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - P C Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - M Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Schlattmann
- Institute of Medical Statistics, Informatics and Documentation (IMSID), Friedrich-Schiller University and University Hospital Jena, Bachstraße 18, 07743, Jena, Germany.
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26
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Siemieniuk RA, Agoritsas T, Manja V, Devji T, Chang Y, Bala MM, Thabane L, Guyatt GH. Transcatheter versus surgical aortic valve replacement in patients with severe aortic stenosis at low and intermediate risk: systematic review and meta-analysis. BMJ 2016; 354:i5130. [PMID: 27683246 PMCID: PMC5040923 DOI: 10.1136/bmj.i5130] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine the effect of transcatheter aortic valve implantation (TAVI) versus surgical replacement of an aortic valve (SAVR) in patients with severe aortic stenosis at low and intermediate risk of perioperative death. DESIGN Systematic review and meta-analysis DATA SOURCES: Medline, Embase, and Cochrane CENTRAL. STUDY SELECTION Randomized trials of TAVI compared with SAVR in patients with a mean perioperative risk of death <8%. REVIEW METHODS Two reviewers independently extracted data and assessed risk of bias for outcomes important to patients that were selected a priori by a parallel guideline committee, including patient advisors. We used the GRADE system was used to quantify absolute effects and quality of evidence. RESULTS 4 trials with 3179 patients and a median follow-up of two years were included. Compared with SAVR, transfemoral TAVI was associated with reduced mortality (risk difference per 1000 patients: -30, 95% confidence interval -49 to -8, moderate certainty), stroke (-20, -37 to 1, moderate certainty), life threatening bleeding (-252, -293 to -190, high certainty), atrial fibrillation (-178, -150 to -203, moderate certainty), and acute kidney injury (-53, -39 to -62, high certainty) but increased short term aortic valve reintervention (7, 1 to 21, moderate certainty), permanent pacemaker insertion (134, 16 to 382, moderate certainty), and moderate or severe symptoms of heart failure (18, 5 to 34, moderate certainty). Compared with SAVR, transapical TAVI was associated higher mortality (57, -16 to 153, moderate certainty, P=0.015 for interaction between transfemoral versus transapical TAVI) and stroke (45, -2 to 125, moderate certainty, interaction P=0.012). No study reported long term follow-up, which is particularly important for structural valve deterioration. CONCLUSIONS Many patients, particularly those who have a shorter life expectancy or place a lower value on the risk of long term valve degeneration, are likely to perceive net benefit with transfemoral TAVI versus SAVR. SAVR, however, performs better than transapical TAVI, which is of interest to patients who are not candidates for transfemoral TAVI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016042879.
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Affiliation(s)
- Reed A Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8 Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8 Division General Internal Medicine, and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Veena Manja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8 Department of Internal Medicine, State University of New York at Buffalo, Buffalo, NY,USA VA WNY Health Care System at Buffalo, Department of Veterans Affairs, Buffalo, NY, USA
| | - Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8
| | - Yaping Chang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8
| | - Malgorzata M Bala
- Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, ON, Canada L8S 4L8
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Abstract
OPINION STATEMENT Transcatheter aortic valve replacement (TAVR) has emerged as an effective treatment alternative in patients with severe aortic stenosis (AS) who are deemed surgically high-risk or ineligible for surgery. Pre-procedural imaging, in particular computed tomography (CT), plays an integral part in the planning and performance of TAVR and is crucial for a successful treatment. Novel technological advances in CT include high-pitch, low kV acquisitions, and iterative reconstruction resulting in high image quality at substantially reduced scan duration, contrast volume, and radiation exposure. Given the high spatial and temporal resolution of the acquisitions, CT angiography provides critical information on the eligibility for the peripheral vascular access, aortic root assessment, as well as the aortic annulus measurements, including the coronary ostia and concomitant cardiac pathology. Pre-procedural CT imaging is key for appropriate device size selection to minimize peri-procedural complications and optimize procedural success. In this article, we review the current state of imaging in the pre-interventional setting of TAVR with a special emphasis on CT.
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28
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Nadjiri J, Nieberler H, Hendrich E, Will A, Pellegrini C, Husser O, Hengstenberg C, Greiser A, Martinoff S, Hadamitzky M. Prognostic value of T1-mapping in TAVR patients: extra-cellular volume as a possible predictor for peri- and post-TAVR adverse events. Int J Cardiovasc Imaging 2016; 32:1625-1633. [PMID: 27460767 DOI: 10.1007/s10554-016-0948-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/21/2016] [Indexed: 11/25/2022]
Abstract
The benefit of a transcatheter aortic valve replacement (TAVR) can differ in patients, and therapy bears severe risks. High-degree aortic stenosis can lead to cardiac damage such as diffuse myocardial fibrosis, evaluable by extra-cellular volume (ECV) in CMR. Therefore, fibrosis might be a possible risk factor for unfavorable outcome after TAVR. We sought to assess the prognostic value of T1-mapping and ECV to predict adverse events during and after TAVR. The study population consisted of patients undergoing clinically indicated TAVR by performing additional CMR with native and contrast-enhanced T1-mapping sequences for additional evaluation of ECV. Study endpoints were congestive heart failure (CHF) and TAVR-associated conduction abnormalities defined as new onset of left bundle branch block (LBBB), AV-Block or implantation of a pacemaker. 94 patients were examined and followed. Median follow up time was 187 days (IQR 79-357 days). ECV was increased (>30 %) in 38 patients (40 %). There was no significant correlation between ECV and death, Hazard ratio (HR) 0.847 (95 % CI 0.335; 2.14), p = 0.72. ECV in patients with subsequent CHF was higher than in those without an event (33.5 ± 4.6 and 29.1 ± 4.1 %, respectively), but the difference just did not reach the level of significance HR 2.16 (95 % CI 0.969; 4.84), p = 0.06. Patients with post-TAVR conduction abnormality (LBBB, AV-block or pacemaker implantation) had statistically relevant lower ECV values compared to those without an event. Patients with an event had a mean ECV of 28.1 ± 3.16 %; patients without an event had a mean ECV of 29.8 ± 4.53, HR 0.56 (95 % CI 0.32; 0.96), p = 0.036. In this study, elevated myocardial ECV is a predictor of CHF by trend; CMR may be helpful in identifying patients with a high risk for post-TAVR cardiac decompensation benefitting from an intensified post-interventional surveillance. Patients with post-TAVR conductions abnormalities have a significantly decreased ECV. Nevertheless, it remains unclear which precise molecular tissue alteration is the protective factor or risk factor in this case.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Hanna Nieberler
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Eva Hendrich
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Albrecht Will
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Costanza Pellegrini
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Oliver Husser
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Christian Hengstenberg
- Department of Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | | | - Stefan Martinoff
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
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29
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Jung JI, Koh YS, Chang K. 3D Printing Model before and after Transcatheter Aortic Valve Implantation for a Better Understanding of the Anatomy of Aortic Root. Korean Circ J 2016; 46:588-9. [PMID: 27482272 PMCID: PMC4965442 DOI: 10.4070/kcj.2016.46.4.588] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/18/2015] [Accepted: 10/29/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon-Seog Koh
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kiyuk Chang
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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30
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Bosi GM, Biffi B, Biglino G, Lintas V, Jones R, Tzamtzis S, Burriesci G, Migliavacca F, Khambadkone S, Taylor AM, Schievano S. Can finite element models of ballooning procedures yield mechanical response of the cardiovascular site to overexpansion? J Biomech 2016; 49:2778-2784. [PMID: 27395759 PMCID: PMC5522534 DOI: 10.1016/j.jbiomech.2016.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 06/09/2016] [Accepted: 06/13/2016] [Indexed: 11/23/2022]
Abstract
Patient-specific numerical models could aid the decision-making process for percutaneous valve selection; in order to be fully informative, they should include patient-specific data of both anatomy and mechanics of the implantation site. This information can be derived from routine clinical imaging during the cardiac cycle, but data on the implantation site mechanical response to device expansion are not routinely available. We aim to derive the implantation site response to overexpansion by monitoring pressure/dimensional changes during balloon sizing procedures and by applying a reverse engineering approach using a validated computational balloon model. This study presents the proof of concept for such computational framework tested in-vitro. A finite element (FE) model of a PTS-X405 sizing balloon (NuMed, Inc., USA) was created and validated against bench tests carried out on an ad hoc experimental apparatus: first on the balloon alone to replicate free expansion; second on the inflation of the balloon in a rapid prototyped cylinder with material deemed suitable for replicating pulmonary arteries in order to validate balloon/implantation site interaction algorithm. Finally, the balloon was inflated inside a compliant rapid prototyped patient-specific right ventricular outflow tract to test the validity of the approach. The corresponding FE simulation was set up to iteratively infer the mechanical response of the anatomical model. The test in this simplified condition confirmed the feasibility of the proposed approach and the potential for this methodology to provide patient-specific information on mechanical response of the implantation site when overexpanded, ultimately for more realistic computational simulations in patient-specific settings.
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Affiliation(s)
- Giorgia M Bosi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK.
| | - Benedetta Biffi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK; Department of Medical Physics & Biomedical Engineering, UCL, London, UK
| | - Giovanni Biglino
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Valentina Lintas
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
| | - Rod Jones
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Spyros Tzamtzis
- UCL Mechanical Engineering, Cardiovascular Engineering Laboratory, University College London, UK
| | - Gaetano Burriesci
- UCL Mechanical Engineering, Cardiovascular Engineering Laboratory, University College London, UK
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Italy
| | - Sachin Khambadkone
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, UK
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31
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Siva S, Ball D. Curing Operable Stage I Non-Small Cell Lung Cancer With Stereotactic Ablative Body Radiotherapy: The Force Awakens. Oncologist 2016; 21:393-8. [PMID: 26984447 PMCID: PMC4828125 DOI: 10.1634/theoncologist.2015-0477] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/02/2016] [Indexed: 12/25/2022] Open
Abstract
In 2016, surgery is the standard of care for peripheral stage I non-small cell lung cancer. However, recent thought-provoking randomized evidence suggests stereotactic ablative body radiotherapy (SABR) has survival outcomes similar to those of surgery. Albeit limited, patient-reported outcomes and quality of life suggest that SABR compares favorably to surgery because it is noninvasive and associated with relatively few treatment-related complications. This article explores the current scientific landscape of surgery and SABR in this patient cohort.
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Affiliation(s)
- Shankar Siva
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - David Ball
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
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32
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Chandola R, Teoh K, Elhenawy A, Christakis G. Perceval Sutureless Valve - are Sutureless Valves Here? Curr Cardiol Rev 2015; 11:220-8. [PMID: 25394851 PMCID: PMC4558353 DOI: 10.2174/1573403x11666141113155744] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 10/28/2014] [Accepted: 11/03/2014] [Indexed: 12/03/2022] Open
Abstract
With the advent of transcatheter aortic valve implantation (TAVI) techniques, a renewed interest has developed in sutureless aortic valve concepts in the last decade. The main feature of sutureless aortic valve implantation is the speed of insertion, thus making implantation easier for the surgeon. As a result, cross clamp times and myocardial ischemia may be reduced. The combined procedures (CABG with AVR in particular) can be done with a short cross clamp time. Perceval valve also provides an increased effective orifice area as compared with a stented bioprosthesis. Sutureless implantation of the Perceval valve is not only associated with shorter cross-clamp and cardiopulmonary bypass times but improved clinical outcomes too. This review covers the sutureless aortic valves and their evolution, with elaborate details on Perceval S valve in particular (which is the most widely used sutureless valve around the globe).
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Affiliation(s)
- Rahul Chandola
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room H4 06, Toronto, ON, M4N 3M5, Canada.
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Cao C, Wolfenden H, Liou K, Pathan F, Gupta S, Nienaber TA, Chandrakumar D, Indraratna P, Yan TD. A meta-analysis of robotic vs. conventional mitral valve surgery. Ann Cardiothorac Surg 2015; 4:305-14. [PMID: 26309839 DOI: 10.3978/j.issn.2225-319x.2014.10.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 10/23/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The present study is the first meta-analysis to compare the surgical outcomes of robotic vs. conventional mitral valve surgery in patients with degenerative mitral valve disease. METHODS A systematic review of the literature was conducted to identify all relevant studies with comparative data on robotic vs. conventional mitral valve surgery. Predefined primary endpoints included mortality, stroke and reoperation for bleeding. Secondary endpoints included cross-clamp time, cardiopulmonary bypass time, length of hospitalization and duration of intensive care unit (ICU) stay. Echocardiographic outcomes were assessed when possible. RESULTS Six relevant retrospective studies with comparative data for robotic vs. conventional mitral valve surgery were identified from the existing literature. Meta-analysis demonstrated a superior perioperative survival outcome for patients who underwent robotic surgery. Incidences of stroke and reoperation were not statistically different between the two treatment arms. Patients who underwent robotic surgery required a significantly longer period of cardiopulmonary bypass time and cross-clamp time. However, the lengths of hospitalization and ICU stay were not significantly different. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes in the majority of patients. CONCLUSIONS Current evidence on comparative outcomes of robotic vs. conventional mitral surgery is limited, and results of the present meta-analysis should be interpreted with caution due to differing patient characteristics. However, it has been demonstrated that robotic mitral valve surgery can be safely performed by expert surgeons for selected patients. A successful robotic program is dependent on a specially trained team and a sufficient volume of referrals to attain and maintain safety.
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Affiliation(s)
- Christopher Cao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Hugh Wolfenden
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Kevin Liou
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Faraz Pathan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Sunil Gupta
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Thomas A Nienaber
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - David Chandrakumar
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Praveen Indraratna
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, 3 Department of Cardiology, Prince of Wales Hospital, Sydney, Australia ; 4 The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
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Najjar M, Yerebakan H, Sorabella RA, Donovan DJ, Kossar AP, Sreekanth S, Kurlansky P, Borger MA, Argenziano M, Smith CR, George I. Acute kidney injury following surgical aortic valve replacement. J Card Surg 2015; 30:631-9. [PMID: 26108804 DOI: 10.1111/jocs.12586] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is a significant complication of surgical aortic valve replacement (SAVR). This study sought to describe AKI following SAVR, its risk factors, predictors and effect on long-term survival. METHODS We retrospectively reviewed 2169 patients who underwent isolated SAVR between 2000 and 2012. The main end-points were occurrence of AKI, postoperative complications, and short- and long-term survival rates following SAVR. Patients were divided into two groups: AKI+ (n = 181) and AKI- (n = 1945). RESULTS AKI occurred in 8.5% of patients, of which 3.9% (n = 7) needed dialysis. Predictors of AKI after SAVR were body mass index (BMI) and intraoperative packed red blood cells (PRBC) transfusion. AKI+ patients had a more complicated postoperative course and higher cumulative mortality (25% vs. 17%, p = 0.012) with a median follow-up of 4.1 years. AKI was not found to be an independent predictor of mortality. CONCLUSIONS Predictors of AKI after SAVR are increased BMI and intraoperative PRBC transfusion. AKI conferred an increase in hospital length of stay and cumulative mortality while the need for postoperative dialysis was associated with the most complicated hospital stays and the highest in-hospital and cumulative mortalities; therefore careful recognition of patients at risk of AKI is warranted for a better preoperative renal optimization. However, incidence of AKI was lower than what is reported after both on-CPB cardiac surgeries and transcatheter aortic valve replacement, moreover AKI was not found to be an independent predictor of mortality.
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Affiliation(s)
- Marc Najjar
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Halit Yerebakan
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Robert A Sorabella
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Denis J Donovan
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Alexander P Kossar
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Sowmyashree Sreekanth
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Paul Kurlansky
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Michael A Borger
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Michael Argenziano
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Craig R Smith
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
| | - Isaac George
- New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, New York
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Shah A, Brambley H, Curtis M, Mullen M, Delahunty N, Yap J, Smith A, Montgomery H, Sanders J. Postoperative morbidity after surgical aortic valve replacement or transcatheter valve implantation: a prospective cohort study. Intensive Care Med 2015; 41:1721-2. [PMID: 26077060 DOI: 10.1007/s00134-015-3862-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Akshay Shah
- Cardiac Intensive Care Unit, The Heart Hospital, UCLH, London, UK,
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Phan K, Tian DH, Cao C, Black D, Yan TD. Systematic review and meta-analysis: techniques and a guide for the academic surgeon. Ann Cardiothorac Surg 2015; 4:112-22. [PMID: 25870806 DOI: 10.3978/j.issn.2225-319x.2015.02.04] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/14/2015] [Indexed: 01/08/2023]
Abstract
With the rapidly growing literature across the surgical disciplines, there is a corresponding need to critically appraise and summarize the currently available evidence so they can be applied appropriately to patient care. The interpretation of systematic reviews is particularly challenging in cases where few robust clinical trials have been performed to address a particular question. However, risk of bias can be minimized and potentially useful conclusions can be drawn if strict review methodology is adhered to, including an exhaustive literature search, quality appraisal of primary studies, appropriate statistical methodology, assessment of confidence in estimates and risk of bias. Therefore, the following article aims to: (I) summarize to the important features of a thorough and rigorous systematic review or meta-analysis for the surgical literature; (II) highlight several underused statistical approaches which may yield further interesting insights compared to conventional pair-wise data synthesis techniques; and (III) propose a guide for thorough analysis and presentation of results.
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Affiliation(s)
- Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - David H Tian
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Christopher Cao
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Deborah Black
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Faculty of Health Sciences, University of Sydney, Sydney, Australia
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Phan K, Tsai YC, Niranjan N, Bouchard D, Carrel TP, Dapunt OE, Eichstaedt HC, Fischlein T, Gersak B, Glauber M, Haverich A, Misfeld M, Oberwalder PJ, Santarpino G, Shrestha ML, Solinas M, Vola M, Yan TD, Di Eusanio M. Sutureless aortic valve replacement: a systematic review and meta-analysis. Ann Cardiothorac Surg 2015; 4:100-11. [PMID: 25870805 DOI: 10.3978/j.issn.2225-319x.2014.06.01] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 04/27/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Sutureless aortic valve replacement (SU-AVR) has emerged as an innovative alternative for treatment of aortic stenosis. By avoiding the placement of sutures, this approach aims to reduce cross-clamp and cardiopulmonary bypass (CPB) duration and thereby improve surgical outcomes and facilitate a minimally invasive approach suitable for higher risk patients. The present systematic review and meta-analysis aims to assess the safety and efficacy of SU-AVR approach in the current literature. METHODS Electronic searches were performed using six databases from their inception to January 2014. Relevant studies utilizing sutureless valves for aortic valve implantation were identified. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS Twelve studies were identified for inclusion of qualitative and quantitative analyses, all of which were observational reports. The minimally invasive approach was used in 40.4% of included patients, while 22.8% underwent concomitant coronary bypass surgery. Pooled cross-clamp and CPB duration for isolated AVR was 56.7 and 46.5 minutes, respectively. Pooled 30-day and 1-year mortality rates were 2.1% and 4.9%, respectively, while the incidences of strokes (1.5%), valve degenerations (0.4%) and paravalvular leaks (PVL) (3.0%) were acceptable. CONCLUSIONS The evaluation of current observational evidence suggests that sutureless aortic valve implantation is a safe procedure associated with shorter cross-clamp and CPB duration, and comparable complication rates to the conventional approach in the short-term.
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Affiliation(s)
- Kevin Phan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Yi-Chin Tsai
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Nithya Niranjan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Denis Bouchard
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Thierry P Carrel
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Otto E Dapunt
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Harald C Eichstaedt
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Theodor Fischlein
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Borut Gersak
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Mattia Glauber
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Axel Haverich
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Martin Misfeld
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Peter J Oberwalder
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Giuseppe Santarpino
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Malakh Lal Shrestha
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Solinas
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Vola
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Tristan D Yan
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Marco Di Eusanio
- 1 The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia ; 2 Department of Cardiothoracic Surgery, The Prince Charles Hospital, Chermside, Australia ; 3 Montreal Heart Institute, Montréal, Canada ; 4 Hopital Universitaire de Berne, Berne, Switzerland ; 5 University Hospital Graz, Graz, Austria ; 6 European Medical School Oldenburg-Groningen, Klinikum Oldenburg, Oldenburg, Germany ; 7 Cardiovascular Center, Paracelsus Medical University, Nuremberg, Germany ; 8 University Medical Center Ljubljana, Ljubljana, Slovenia ; 9 Pasquinucci Heart Hospital, Massa, Italy ; 10 Hannover Medical School, Hannover, Germany ; 11 University of Leipzig, Leipzig, Germany ; 12 Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France ; 13 Cardiovascular Surgery Department, Sant'Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
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Glauber M, Ferrarini M, Miceli A. Minimally invasive aortic valve surgery: state of the art and future directions. Ann Cardiothorac Surg 2015; 4:26-32. [PMID: 25694973 DOI: 10.3978/j.issn.2225-319x.2015.01.01] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/02/2015] [Indexed: 11/14/2022]
Abstract
Minimally invasive aortic valve replacement (MIAVR) is defined as an aortic valve replacement (AVR) procedure that involves a small chest wall incision as opposed to conventional full sternotomy (FS). The MIAVR approach is increasingly being used with the aim of reducing the "invasiveness" of the surgical procedure, while maintaining the same efficacy, quality and safety of a conventional approach. The most common MIAVR techniques are ministernotomy (MS) and right anterior minithoracotomy (RT) approaches. Compared with conventional surgery, MIAVR has been shown to reduce postoperative mortality and morbidity, providing faster recovery, shorter hospital stay and better cosmetics results, requires less rehabilitations resources and consequently cost reduction. Despite these advantages, MIAVR is limited by the longer cross-clamp and cardiopulmonary bypass (CPB) times, which have raised some concerns in fragile and high risk patients. However, with the introduction of sutureless and fast deployment valves, operative times have dramatically reduced by 35-40%, standardizing this procedure. According to these results, the MIAVR approach using sutureless valves may be the "real alternative" to the transcatheter aortic valve implantation (TAVI) procedures in high risk patients "operable" patients. Prospective randomized trials are required to confirm this hypothesis.
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Affiliation(s)
- Mattia Glauber
- Cardiac Surgery and Great Vessels Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Matteo Ferrarini
- Cardiac Surgery and Great Vessels Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Antonio Miceli
- Cardiac Surgery and Great Vessels Department, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
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Boix-Garibo R, Uzzaman MM, Bapat VN. Review of Minimally Invasive Aortic Valve Surgery. Interv Cardiol 2015; 10:144-148. [PMID: 29588692 DOI: 10.15420/icr.2015.10.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Minimally invasive aortic valve surgery (MIAVS) has been developed for the last 20 years. The improvements in techniques have permitted cardiac surgeons to perform aortic valve replacement safely and efficiently with minimally incisions. Patients have become older and have multiple comorbidities and this is expected to grow in number. Less-invasive procedures are known to reduce the number of complications, together with smaller incisions, less pain, less blood loss and reduced length of hospital stay. Selective preoperative planning with computed tomography is key to the pre-investigation stage. Hybrid and staged procedures with interventional cardiologists are part of the armamentarium and may be appealing for the present and near future. Despite the nature of demanding procedures and longer learning curve with increased cardiopulmonary bypass times, the outcomes are comparable with same quality as conventional open surgery. Patient recovery is the ultimate purpose of these approaches.
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Affiliation(s)
- Ricardo Boix-Garibo
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Vinayak Nilkanth Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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40
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Abstract
Transcatheter aortic valve implantation was developed to offer a therapeutic solution to patients with severe symptomatic aortic stenosis who are not candidates for conventional aortic valve replacement. The improvement in transcatheter aortic valve implantation outcomes is still of concern in the areas of stroke, vascular injury, heart block, paravalvular regurgitation and valve durability. Concomitantly, the progress, both technical and in terms of material advances of transcatheter valve systems, as well as in patient selection, renders transcatheter aortic valve implantation an increasingly viable treatment for more and more patients with structural heart disease.
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41
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Nagaraja V, Raval J, Eslick GD, Ong ATL. Transcatheter versus surgical aortic valve replacement: a systematic review and meta-analysis of randomised and non-randomised trials. Open Heart 2014; 1:e000013. [PMID: 25332780 PMCID: PMC4189306 DOI: 10.1136/openhrt-2013-000013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 05/26/2014] [Accepted: 07/15/2014] [Indexed: 12/18/2022] Open
Abstract
Introduction Many patients deemed inoperable for surgical aortic valve replacement (SAVR) have been treated successfully by transcatheter aortic-valve replacement (TAVR). This meta-analysis is designed to evaluate the performance of TAVR in comparison with SAVR. Methods A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, the Cochrane library, Google Scholar, Science Direct and Web of Science. Original data were abstracted from each study and used to calculate a pooled OR and 95% CI. Results Among three randomised controlled trials (RCTs), differences between the two cohorts were not statistically significant for the frequency of stroke (OR=1.94, 95% CI=0.813 to 4.633), incidence of myocardial infarction (MI), (OR=0.765, 95% CI=0.05 to 11.76) 30-day mortality rate, 1-year mortality rate (0.82, 95% CI=0.62 to 1.09) and acute kidney injury incidence rate. The non-RCTs demonstrated that the TAVR group had an amplified frequency aortic regurgitation at discharge (OR=5.465, 95% CI=3.441 to 8.680). While differences between the two cohorts were not statistically significant for the incidence of MI (OR=0.697, 95% CI=0.22 to 2.21), stroke (OR=0.575, 95% CI=0.263 to 1.259), acute renal failure requiring haemodialysis (OR=0.943, 95% CI=0.276 to 3.222), 30-day mortality (OR=0.869, 95% CI=0.621 to 1.216) and the need for a pacemaker (OR=1.832, 95% CI=0.869 to 3.862), a lower incidence of patients needing transfusion (OR=0.349, 95% CI=0.121 to 1.005) and new-onset atrial fibrillation (OR=0.296, 95% CI=0.124 to 0.706) was seen in the TAVR group. Conclusions Randomised and observational evidence adjusted on the baseline patient’s characteristics finds a similar risk for 30 days mortality, 1-year mortality, stroke, MI and acute kidney injury in TAVR and SAVR.
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Affiliation(s)
- Vinayak Nagaraja
- Prince of Wales Clinical School, University of New South Wales, Prince of Wales Hospital, Australia ; The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
| | - Jwalant Raval
- Department of Cardiology, Blacktown Hospital, Australia
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, Discipline of Surgery, The University of Sydney, Nepean Hospital, Sydney, NSW, Australia
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Cao C, Gupta S, Chandrakumar D, Nienaber TA, Indraratna P, Ang SC, Phan K, Yan TD. A meta-analysis of minimally invasive versus conventional mitral valve repair for patients with degenerative mitral disease. Ann Cardiothorac Surg 2014; 2:693-703. [PMID: 24349970 DOI: 10.3978/j.issn.2225-319x.2013.11.08] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 11/08/2013] [Indexed: 11/14/2022]
Abstract
BACKGROUND Minimally invasive mitral valve surgery through a mini-thoracotomy approach was developed in the mid-1990s as an alternative to conventional sternotomy, but with reduced trauma and quicker recovery. However, technical demands and a paucity of comparative data have thus far limited the widespread adoption of minimally invasive mitral valve repair (MIMVR). Previous meta-analyses have grouped various surgical techniques and underlying valvular disease aetiologies together for comparison. The present study aimed to compare the clinical outcomes of MIMVR versus conventional mitral valve repair in patients with degenerative mitral valve disease. METHODS A systematic review of the current literature was performed through nine electronic databases from January 1995 to July 2013 to identify all relevant studies with comparative data on MIMVR versus conventional mitral valve surgery. Measured endpoints included mortality, stroke, renal failure, wound infection, reoperation for bleeding, aortic dissection, myocardial infarction, atrial fibrillation, readmission within 30 days, cross clamp time, cardiopulmonary bypass time and durations of intensive care unit (ICU) stay and overall hospitalization. Echocardiographic outcomes were also assessed when possible. RESULTS Seven relevant studies were identified according to the predefined study selection criteria, including one randomized controlled trial and six retrospective studies. Meta-analysis of clinical outcomes did not identify any statistically significant differences between MIMVR and conventional mitral valve repair. The duration of ICU stay was significantly shorter for patients who underwent MIMVR, but this did not translate to a shorter hospitalization period. Patients who underwent MIMVR required longer cross clamp time as well as cardiopulmonary bypass time. Both surgical techniques appeared to achieve satisfactory echocardiographic outcomes. Pain-related outcomes was assessed in one study and reported significantly less pain for patients who underwent MIMVR. However, this limited data was not suitable for meta-analysis. CONCLUSIONS The existing literature has limited data on comparative outcomes after MIMVR versus conventional mitral valve repair for patients with degenerative disease. From the available evidence, there are no significant differences between the two surgical techniques in regards to clinical outcomes. Patients who underwent MIMVR required longer cardiopulmonary bypass and cross clamp times, but the duration of stay in the ICU was significantly shorter than conventional mitral valve repair.
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Affiliation(s)
- Christopher Cao
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Sunil Gupta
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - David Chandrakumar
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Thomas A Nienaber
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Praveen Indraratna
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Su C Ang
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Kevin Phan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
| | - Tristan D Yan
- The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia; ; The Royal Prince Alfred Hospital, Sydney University, Sydney, Australia
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Kim CA, Rasania SP, Afilalo J, Popma JJ, Lipsitz LA, Kim DH. Functional status and quality of life after transcatheter aortic valve replacement: a systematic review. Ann Intern Med 2014; 160:243-54. [PMID: 24727842 PMCID: PMC4039034 DOI: 10.7326/m13-1316] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The functional and quality-of-life benefits of transcatheter aortic valve replacement (TAVR) have not been established. PURPOSE To evaluate the changes in functional status and quality of life after TAVR. DATA SOURCES MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from 1 January 2002 to 30 September 2013. STUDY SELECTION Studies of TAVR that reported the New York Heart Association (NYHA) class, Short Form-12/36 Health Survey physical and mental component summary (points), or other measures of functional status. DATA EXTRACTION Two reviewers independently extracted the mean change (follow-up minus baseline) in primary outcomes. Because of substantial heterogeneity, data were not pooled; the range of mean change was summarized. DATA SYNTHESIS We identified 60 observational studies (56 pre–post comparison and 4 head-to-head comparative studies) and 2 randomized, controlled trials (11 205 patients). Most studies showed a clinically important decrease in NYHA class at 6 to 11 months (range, -0.8 to -2.1 classes) and 12 to 23 months (range, -0.8 to -2.1 classes). The improvement in the Short Form-12/36 Health Survey physical component score was clinically important over 12 months (range, 4.9 to 26.9 points), and the change in mental component score was smaller (range, 1.0 to 8.9 points).Clinically important improvements were seen in other disease-specific measures but were less consistently seen in general health measures. LIMITATIONS Comparative evidence is limited by few head-to-head studies. Survivor bias may have overestimated the benefits. CONCLUSION Transcatheter aortic valve replacement provides clinically important benefits in physical function and disease-specific measures of quality of life but modest benefits in psychological and general health measures. More comparative studies on functional status and quality of life are needed for informed treatment decision making.
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Affiliation(s)
- Caroline A. Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Suraj P. Rasania
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jonathan Afilalo
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Jeffrey J. Popma
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Lewis A. Lipsitz
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
| | - Dae Hyun Kim
- From Beth Israel Deaconess Medical Center, Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts; Jewish General Hospital and McGill University, Montreal, Quebec, Canada; and Geisinger Medical Center, Danville, Pennsylvania
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Holzhey D. Re: Systematic review and meta-analysis of transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis. Ann Cardiothorac Surg 2013; 2:144-5. [PMID: 23977573 DOI: 10.3978/j.issn.2225-319x.2013.01.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 01/21/2013] [Indexed: 11/14/2022]
Affiliation(s)
- David Holzhey
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
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