Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States

Masha, Luke; Vemulapalli, Sreekanth; Manandhar, Pratik; Balan, Prakash; Shah, Pinak; Kosinski, Andrzej S.; Stewart, Garrick C.

doi:10.1016/j.jcin.2020.02.033

Cited by 31 publications

(20 citation statements)

References 13 publications

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“…This study shows that a spectrum of individually rare complications together still result in a relatively high adverse event rate in patients currently undergoing TAVI. The incidences of the evaluated events were fairly comparable with recent reports of other Dutch [10], European [11,12], American [12,13] and Asian [14] TAVI registries of real-world patients. Rates of stroke and mortality were, however, on the high end of the spectrum, while bleeding complications were on the low end [10][11][12][13][14].…”

Section: Discussionsupporting

confidence: 85%

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Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

et al. 2021

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Introduction Despite considerable advances in the last decade, major adverse events remain a concern after transcatheter aortic valve implantation (TAVI). The aim of this study was to provide a detailed overview of their underlying causes and contributing factors in order to identify key domains for quality improvement. Methods This observational, prospective registry included all patients undergoing TAVI between 31 December 2015 and 1 January 2020 at the St. Antonius Hospital in Nieuwegein and the University Medical Centre in Utrecht. Outcomes of interest were all-cause mortality, stroke, major bleeding, life-threatening or disabling bleeding, major vascular complications, myocardial infarction, severe acute kidney injury and conduction disturbances requiring permanent pacemaker implantation within 30 days after TAVI, according to the Valve Academic Research Consortium‑2 criteria. Results Of the 1250 patients who underwent TAVI in the evaluated period, 146 (11.7%) developed a major complication. In 54 (4.3%) patients a thromboembolic event occurred, leading to stroke in 36 (2.9%), myocardial infarction in 13 (1.0%) and lower limb ischaemia in 11 (0.9%). Major bleeding occurred in 65 (5.2%) patients, most frequently consisting of acute cardiac tamponade (n = 25; 2.0%) and major access-site bleeding (n = 21; 1.7%). Most complications occurred within 1 day of the procedure. Within 30 days a total of 54 (4.3%) patients died, the cause being directly TAVI-related in 30 (2.4%). Of the patients who died from causes that were not directly TAVI-related, 14 (1.1%) had multiple hospital-acquired complications. Conclusion A variety of underlying mechanisms and causes form a wide spectrum of major threats affecting early safety in 11.7% of patients undergoing TAVI in a contemporary cohort of real-world patients.

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Section: Discussionsupporting

confidence: 85%

“…The incidences of the evaluated events were fairly comparable with recent reports of other Dutch [10], European [11,12], American [12,13] and Asian [14] TAVI registries of real-world patients. Rates of stroke and mortality were, however, on the high end of the spectrum, while bleeding complications were on the low end [10][11][12][13][14].…”

Section: Discussionsupporting

confidence: 85%

Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

et al. 2021

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“…From a large national TAVI registry of the United States, the incidence of TAVI performed in cardiogenic shock patients was 4.1% and the 30-day mortality was 19.1%. 8) According to Fraccaro et al, the 1-year mortality and heart failure readmission rate were 25.7% and 8.6%, respectively. 9) Cardiogenic shock with acutely decompensated AS portends a dismal prognosis; however, the lesson from our case is that prompt management with emergent TAVI and mechanical circulatory support is feasible and may result in a favorable outcome.…”

Section: Discussionmentioning

confidence: 98%

Survival of Severe Aortic Stenosis Complicated with Cardiogenic Shock by Emergent Transcatheter Aortic Valve Implantation and Intra-Aortic Balloon Pump

Kimura

Ando

Onishi

et al. 2021

Journal of Transcatheter Valve Therapies

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To learn the management of severe aortic stenosis (AS) complicated by cardiogenic shock. Case Presentation: The case was an 89-year-old female with a past medical history of diabetes and stroke. She presented to another hospital after a syncopal episode. While waiting for further evaluation, she suddenly became unresponsive, and the monitor showed asystole. She was immediately resuscitated, and transthoracic echocardiography showed severe AS. Therefore, she was transferred to our hospital for further management including transcatheter aortic valve implantation (TAVI). During echocardiography, the patient developed hypotension and diffuse ST-segment depression. Transthoracic echocardiography revealed severe mitral regurgitation with preserved ejection fraction. Emergent coronary angiography did not show significant stenosis, and the patient was considered to be in cardiogenic shock secondary to severe AS. Emergent TAVI was performed under intra-aortic balloon support. Post TAVI course was uneventful, and at 1-year follow-up, the patient was in stable condition. Echocardiography at 1 year showed normal prosthetic valve function and mild mitral regurgitation. Conclusion: Favorable outcome of severe AS complicated with cardiogenic shock could be achieved with emergent TAVI and mechanical circulatory support. Further study is warranted to identify risk factors for acute decompensation of AS causing cardiogenic shock.

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“…The mortality in this population was not secondary to procedural complications, but due to the degree of the shock itself. 9 Since we included data till 2014 the indication of TAVI was largely restricted to high-risk patients. The less readmission risk and reintervention risk in urgent TAVI group is encouraging in this high-risk population.…”

Section: Discussionmentioning

confidence: 99%

Readmission following urgent transcatheter aortic valve implantation versus urgent balloon aortic valvuloplasty in patients with decompensated heart failure or cardiogenic shock

Chakraborty

Patel

Bandyopadhyay

et al. 2021

Cathet Cardio Intervent

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Background: Urgent transcatheter aortic valve implantation (TAVI) is a feasible option for aortic stenosis (AS) patients with decompensated heart failure (HF) and cardiogenic shock (CS) as compared to the more traditional urgent balloon aortic valvuloplasty (BAV).Objectives: We conducted a retrospective analysis to compare risk and cause of readmission in these two high-risk groups.Methods: Nationwide Readmission Database (NRD) 2011-2014 was retrospectively analyzed to identify patients with AS having either urgent TAVI or urgent BAV using appropriate ICD-9 codes. Propensity scores were used to match patients with urgent TAVI as compared to patients with urgent BAV. Statistical analysis was performed using the Stata 15.1 software. Results:We identified a weighted sample of 6,670 patients with urgent BAV and 6,964 patients with urgent TAVI. The all-cause 30-and 90-day readmission was lower in the urgent TAVI group compared to urgent BAV (15.4 vs. 22.5%, (aHR): 0.92 [0.90-0.95] p < .001). 30-day readmission due to CV cause and HF was also lower in the urgent TAVI group (aHR, 0.93: p < .001 and aHR, 0.98: p = .040, respectively). The 30-day gastrointestinal (GI) bleed readmission rate was three times higher in urgent TAVI group (aHR, 3.00:95% CI (1.23-7.33), p = .016), but was not statistically significant at 90-days.Cardiac causes of readmission were the predominant cause of readmission in both groups, but more pronounced in urgent BAV group (60.3 vs. 40.5%, p < .001). Conclusion:Urgent TAVI appears beneficial in patients with AS and decompensated HF or CS driven by roughly 10 and 25% reductions in overall readmissions at 30 and 90 days, and marked reductions in reintervention, although offset partially by higher risk of readmission due to GI bleeding at 30 days.

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Demographics, Procedural Characteristics, and Clinical Outcomes When Cardiogenic Shock Precedes TAVR in the United States

Cited by 31 publications

References 13 publications

Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients

Survival of Severe Aortic Stenosis Complicated with Cardiogenic Shock by Emergent Transcatheter Aortic Valve Implantation and Intra-Aortic Balloon Pump

Readmission following urgent transcatheter aortic valve implantation versus urgent balloon aortic valvuloplasty in patients with decompensated heart failure or cardiogenic shock

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