Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation

Akintoye, Emmanuel; Ando, Tomo; Sandio, Aubin; Adegbala, Oluwole; Salih, M. A. M.; Zubairu, Josiah; Oseni, Abdullahi; Sistla, Phanicharan; Alqasrawi, Musab; Egbe, Alexander C.; Mentias, Amgad; Afonso, Luís; Briasoulis, Αlexandros; Panaich, Sidakpal; Desai, Milind Y.

doi:10.1016/j.amjcard.2020.03.038

Cited by 8 publications

(17 citation statements)

References 31 publications

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“…With the advances in preprocedural planning of TAVR and iteration of devices with smaller delivery systems, outcomes of TAVR have improved both in the overall population and in high‐risk groups 11,15 . Although our study showed a significant decrease in the crude in‐hospital mortality rate in TAVR on CD, this did not remain significant after adjustments for demographic, hospital characteristics, and procedural years.…”

Section: Discussioncontrasting

confidence: 56%

“…With accumulating experience and improvement in technologies, transcatheter aortic valve replacement (TAVR) has demonstrated continuous improvement in clinical outcomes. 1,2 Patients on chronic dialysis (CD), however, have been excluded from major randomized controlled trials. [3][4][5][6] This patient population is at increased risk for valve calcification, and approximately 50% of patients with renal dysfunction have concomitant aortic stenosis.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

et al. 2020

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Background and Aim: Trends of utilization and outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for patients on chronic dialysis (CD) are not well described. We aimed to assess the trends in utilization and outcomes of TAVR and SAVR on CD. Methods: Nationwide Readmission Databases from 2013 to 2017 was analyzed. International Classification of Diseases Clinical Modification 9 and 10 codes were used to identify diagnoses and procedures. A multivariable regression model was used to compare the outcomes expressed as adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: A total of 5731 TAVR and 6491 SAVR were performed in patients with CD, respectively. The volume of TAVR increased by approximately four-folds and SAVR increased by approximately 33%. However, amongst patients with CD, the percentage of TAVR increased, whereas that of SAVR decreased (p < .001 for all). In 2016 and 2017, TAVR volume surpassed that of SAVR on CD. In-hospital mortality remained similar in TAVR (aOR: 0.92; 95% CI: 0.79-1.07; p-trend = .23) whereas it increased significantly in SAVR (aOR: 1.14: 95% CI: 1.05-1.25, p-trend = .002). In 2017, in-hospital mortality and 30-day readmission were significantly higher in TAVR among CD than non-CD patients. Conclusion: Despite increased use of TAVR among CD, there still is an opportunity for improvement in outcome of aortic valve replacement for those on CD.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 99%

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Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

et al. 2020

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“… 5 Ultimately, most symptomatic patients are treated with TAVR because of the potential for clinical improvement—a trend that has led to very high utilization of TAVR. 6 …”

Section: Introductionmentioning

confidence: 99%

“…The hazards associated with these markers are modest, and despite multivariate modeling, our ability to identify patients in advance of treatment who are unlikely to benefit from TAVR remains limited 5 . Ultimately, most symptomatic patients are treated with TAVR because of the potential for clinical improvement—a trend that has led to very high utilization of TAVR 6 …”

Section: Introductionmentioning

confidence: 99%

Left ventricular stroke volume index following transcatheter aortic valve replacement is an early predictor of 1‐year survival

Annamalai

Koethe

Simsolo

et al. 2022

Clinical Cardiology

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Background Adverse cardiac events are common following transcatheter aortic valve replacement (TAVR). Our aim was to investigate the low left ventricular stroke volume index (LVSVI) 30 days after TAVR as an early echocardiographic marker of survival. Hypothesis Steady‐state (30‐day) LVSVI after TAVR is associated with 1‐year mortality. Methods A single‐center retrospective analysis of all patients undergoing TAVR from 2017 to 2019. Baseline and 30‐day post‐TAVR echocardiographic LVSVI were calculated. Patients were stratified by pre‐TAVR transaortic gradient, surgical risk, and change in transvalvular flow following TAVR. Results This analysis focuses on 238 patients treated with TAVR. The 1‐year mortality rate was 9% and 124 (52%) patients had normal flow post‐TAVR. Of those with pre‐TAVR low flow, 67% of patients did not normalize LVSVI at 30 days. The 30‐day normal flow was associated with lower 1‐year mortality when compared to low flow (4% vs. 14%, p = .007). This association remained significant after adjusting for known predictors of risk (adjusted odds ratio [OR] of 3.45, 95% confidence interval: 1.02–11.63 [per 1 ml/m 2 decrease], p = .046). Normalized transvalvular flow following TAVR was associated with reduced mortality (8%) when compared to those with persistent (15%) or new‐onset low flow (12%) ( p = .01). Conclusions LVSVI at 30 days following TAVR is an early echocardiographic predictor of 1‐year mortality and identifies patients with worse intermediate outcomes. More work is needed to understand if this short‐term imaging marker might represent a novel therapeutic target.

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Alerting trends in epidemiology for calcific aortic valve disease, 1990–2019: An age–period–cohort analysis for the Global Burden of Disease Study 2019

Shu

Yang

Sun

et al. 2023

European Heart Journal - Quality of Care and Clinical Outcomes

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Aims To assess the trends in calcific aortic valve disease (CAVD) epidemiology, with an emphasis on CAVD mortality, leading risk factors, and their associations with age, period, and birth cohort. Methods and results Prevalence, disability-adjusted life years (DALYs), and mortality were derived from the Global Burden of Disease Study 2019. The age-period-cohort model was employed to study the detailed trends of CAVD mortality and its leading risk factors. Globally, CAVD showed unsatisfactory results from 1990 to 2019, with the CAVD deaths of 127 000 in 2019. CAVD mortality was substantially reduced in high Socio-demographic Index (SDI) countries (−1.45%, 95% confidence interval (CI) [−1.61, −1.30]), mildly increased in high-middle SDI countries (0.22%, 95% CI [0.06, 0.37]), and unchanged in other SDI quintiles. There was a noticeable transition in CAVD deaths from younger to older populations globally. The CAVD mortality increased exponentially with age, and the male had higher mortality than the female before 80 years old. Favorable period (0.69, 95% CI [0.66, 0.72]) and birth effects (0.30, 95% CI [0.22, 0.43]) were mainly observed in high SDI countries, while unfavorable effects were mostly noticed in high-middle SDI countries. High systolic blood pressure was the leading risk factor of CAVD deaths globally and it showed favorable trends in high SDI regions. Conclusions Although CAVD mortality reduction was observed globally, unfavorable period and cohort effects were found in many countries. Increase of mortality rate among the population ≥ 85 years was the common challenge across all SDI quintiles, stressing the necessity to further improve health care for CAVD patients worldwide.

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Aortic Valve Replacement for Severe Aortic Stenosis Before and During the Era of Transcatheter Aortic Valve Implantation

Cited by 8 publications

References 31 publications

Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

Trends of utilization and outcomes after transcatheter and surgical aortic valve replacement on chronic dialysis

Left ventricular stroke volume index following transcatheter aortic valve replacement is an early predictor of 1‐year survival

Alerting trends in epidemiology for calcific aortic valve disease, 1990–2019: An age–period–cohort analysis for the Global Burden of Disease Study 2019

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