Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement

Saia, Francesco; Latib, Azeem; Ciuca, Cristina; Gasparetto, Valeria; Napodano, Massimo; Sticchi, Alessandro; Anderlucci, Laura; Marrozzini, Cinzia; Naganuma, Toru; Alfieri, Ottavio; Facchin, Michela; Hoxha, Brunilda; Moretti, Carolina; Marzocchi, Antonío; Colombo, Antonio; Tarantini, Giuseppe

doi:10.1016/j.ahj.2014.07.023

Cited by 35 publications

(22 citation statements)

References 30 publications

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“…Thus, the initially high excess mortality, induced by the index AS and associated TAVI, decreased significantly within the first year. This supports previous work using cause of death information, which demonstrated that, although most short‐term mortalities were cardiovascular and procedure related, beyond 24 months, noncardiovascular causes became the leading cause of death . Moreover, the RS rates reported in this study approximately compare with the cardiovascular causes of death reported in the high‐ and intermediate‐risk PARTNER (Placement of Aortic Transcatheter Valves) randomized trials .…”

Section: Discussionsupporting

confidence: 89%

“…The 1‐year all‐cause survival rates reported in this study compare with those from other national registries, but these do not account for competing causes of death. Without cause of death information, the expected mortality risks derived from the life tables are a suitable proxy for competing causes of death, given the low prevalence of TAVI procedures undertaken across the general population.…”

Section: Discussionmentioning

confidence: 91%

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Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Martin

Sperrin

Hulme

et al. 2017

JAHA

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BackgroundTranscatheter aortic valve implantation (TAVI) is indicated for patients with aortic stenosis who are intermediate‐high surgical risk. Although all‐cause mortality rates after TAVI are established, survival attributable to the procedure is unclear because of competing causes of mortality. The aim was to report relative survival (RS) after TAVI, which accounts for background mortality risks in a matched general population.Methods and ResultsNational cohort data (n=6420) from the 2007 to 2014 UK TAVI registry were matched by age, sex, and year to mortality rates for England and Wales (population, 57.9 million). The Ederer II method related observed patient survival to that expected from the matched general population. We modelled RS using a flexible parametric approach that modelled the log cumulative hazard using restricted cubic splines. RS of the TAVI cohort was 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. By 1‐year follow‐up, mortality hazards in the >85 years age group were not significantly different from those of the matched general population; by 3 years, survival rates were comparable. The flexible parametric RS model indicated that increasing age was associated with significantly lower excess hazards after the procedure; for example, by 2 years, a 5‐year increase in age was associated with 20% lower excess mortality over the general population.Conclusions RS after TAVI was high, and survival rates in those aged >85 years approximated those of a matched general population within 3 years. High rates of RS indicate that patients selected for TAVI tolerate the risks of the procedure well.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 91%

Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Martin

Sperrin

Hulme

et al. 2017

JAHA

View full text Add to dashboard Cite

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“…Just as concomitant cardiovascular disease portends poor survival in patients with multimorbidity, the reverse is also true. It is well established that in patients with a variety of chronic cardiovascular conditions, non-cardiovascular comorbidity is associated with increased mortality [28–30]. For example, patients hospitalized with myocardial infarction with multiple noncardiac comorbidities had longer hospital stays and were less likely to survive to hospital discharge [28].…”

Section: Multimorbidity: Scope Of the Problemmentioning

confidence: 99%

Multimorbidity in Older Patients with Cardiovascular Disease

Dunlay

Chamberlain

2016

Curr Cardiovasc Risk Rep

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Multimorbidity affects more than two thirds of older individuals and the vast majority of patients with chronic cardiovascular disease. Patients with multimorbidity have high resource utilization, poor mobility, and poor health status and are at an increased risk for death. The presence of multimorbidity imposes numerous management challenges in caring for patients with chronic cardiovascular disease. It complicates decision-making, promotes fragmented care, and imposes an immense burden on the patient and their social support system. Novel models of care, such as the cardiovascular patient-centered medical home, are needed to provide high-quality, efficient, effective care to this growing population.

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“…Not only does CKD negatively affect outcomes, its presence can complicate the pre-procedural assessment of a potential TAVR patient due to increased risk of contrast-induced nephropathy. (12,13) While conflicting publications on the causative effect of contrast-induced nephropathy exist, Ahmed and Newhouse acknowledge its existence (14), though in reality no prospective study has focused on high-risk patients with severe CKD, severe aortic stenosis with heart failure and other high-risk comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Very low intravenous contrast volume protocol for computed tomography angiography providing comprehensive cardiac and vascular assessment prior to transcatheter aortic valve replacement in patients with chronic kidney disease

Pulerwitz

Khalique

Nazif

et al. 2016

Journal of Cardiovascular Computed Tomography

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Background Transcatheter aortic valve replacement (TAVR) is a lifesaving procedure for many patients high risk for surgical aortic valve replacement. The prevalence of chronic kidney disease (CKD) is high in this population, and thus a very low contrast volume (VLCV) computed tomography angiography (CTA) protocol providing comprehensive cardiac and vascular imaging would be valuable. Methods 52 patients with severe, symptomatic aortic valve disease, undergoing pre-TAVR CTA assessment from 2013-4 at Columbia University Medical Center were studied, including all 26 patients with CKD (eGFR<30mL/min) who underwent a novel VLCV protocol (20mL of iohexol at 2.5mL/s), and 26 standard-contrast-volume (SCV) protocol patients. Using a 320-slice volumetric scanner, the protocol included ECG-gated volume scanning of the aortic root followed by medium-pitch helical vascular scanning through the femoral arteries. Two experienced cardiologists performed aortic annulus and root measurements. Vascular image quality was assessed by two radiologists using a 4-point scale. Results VLCV patients had mean(±SD) age 86±6.5, BMI 23.9±3.4 kg/m2 with 54% men; SCV patients age 83±8.8, BMI 28.7±5.3 kg/m2, 65% men. There was excellent intra- and inter-observer agreement for annular and root measurements, and excellent agreement with 3D-transesophageal echocardiographic measurements. Both radiologists found diagnostic-quality vascular imaging in 96% of VLCV and 100% of SCV cases, with excellent inter-observer agreement. Conclusions This study is the first of its kind to report the feasibility and reproducibility of measurements for a VLCV protocol for comprehensive pre-TAVR CTA. There was excellent agreement of cardiac measurements and almost all studies were diagnostic quality for vascular access assessment.

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Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement

Cited by 35 publications

References 30 publications

Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Multimorbidity in Older Patients with Cardiovascular Disease

Very low intravenous contrast volume protocol for computed tomography angiography providing comprehensive cardiac and vascular assessment prior to transcatheter aortic valve replacement in patients with chronic kidney disease

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