Optimal pain management after aortic valve implantation: an opportunity to improve outcomes after transapical access in the future?

Dworakowski, Rafał; Wendler, Olaf

doi:10.1136/heartjnl-2012-302876

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…B-type natriuretic peptide (BNP) has been shown to be a good predictor of AKI after other forms of cardiac surgery [ 20 ] and a general predictor of outcome in patients with AKI [ 21 ]. Consistent with previously published data [ 22 ] we noticed a significant increase in BNP after TAVI with a greater BNP rise in patients developing AKI. Elevations of BNP may primarily reflect AKI instead of LV dysfunction in this setting.…”

Section: Discussionsupporting

confidence: 93%

Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation

et al. 2022

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Background: Acute kidney injury (AKI) is a frequent complication of transcatheter aortic valve implantation (TAVI) and has been linked to preexisting comorbidities, peri-procedural hypotension, and systemic inflammation. The extent of systemic inflammation after TAVI is not fully understood. Our aim was to characterize the inflammatory response after TAVI and evaluate its contribution to the mechanism of post-procedural AKI.Methods: One hundred and five consecutive patients undergoing TAVI at our institution were included. We analyzed the peri-procedural inflammatory and oxidative stress responses by measuring a range of biomarkers (including C-reactive protein [hsCRP], cytokine levels, and myeloperoxidase [MPO]), before TAVI and 6, 24, and 48 hours post-procedure. We correlated this with changes in renal function and patient and procedural characteristics. Results:We observed a significant increase in plasma levels of pro-inflammatory cytokines (hsCRP, interleukin 6, tumor necrosis factor alpha receptors) and markers of oxidative stress (MPO) after TAVI. The inflammatory response was significantly greater after trans-apical (TA) TAVI compared to trans-femoral (TF). This was associated with a higher incidence of AKI in the TA cohort compared to TF (44% vs. 8%, respectively, p < 0.0001). The incidence of AKI was significantly lower when Nacetylcysteine (NAC) was given peri-procedurally (12% vs. 38%, p < 0.005). In multivariate analysis, only the TA approach and no use of NAC before the procedure were independent predictors of AKI.Conclusions: TAVI creates a significant post-procedural inflammatory response, more so with the TA approach. Mechanisms of AKI after TAVI are complex.Inflammatory response, hypoperfusion, and oxidative stress may all play a part and are potential therapeutic targets to reduce/prevent AKI.

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Section: Discussionsupporting

confidence: 93%

Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation

et al. 2022

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“…Most TAVR teams prefer the transfemoral approach as it avoids surgical manipulation of the chest and reduces post-operative pain. 42 It is also the least invasive method. 43 However, thoracic epidural analgesia provided during transapical TAVR can significantly reduce pain and periprocedural respiratory complications.…”

Section: Aortic Valve Interventionsmentioning

confidence: 99%

Almanah 2013: Novel non-coronary cardiac interventions the national society journals present selected research that has driven recent advances in clinical cardiology

Meier¹,

Franzen²,

Lansky³

2014

Srce i krvni sudovi

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Almanah 2013: novel non-coronary cardiac interventionsThe national society journals present selected research that has driven recent advances in clinical cardiology.Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them. Abstract

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“…Most TAVR teams prefer the transfemoral approach as it avoids surgical manipulation of the chest and reduces postoperative pain 42. It is also the least invasive method 43.…”

Section: Aortic Valve Interventionsmentioning

confidence: 99%

Almanac 2013: Novel non-coronary cardiac interventions

Meier

Franzen²,

Lansky

2013

Heart

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Recent innovations in interventional cardiology have dramatically expanded the therapeutic options for patients with cardiac conditions. Interventional cardiology is no longer limited to the treatment of coronary artery disease but allows also treatment of valvular disease, stroke prevention, hypertension, etc. One of the most important new treatment options is the percutaneous treatment for aortic valve stenosis (transcatheter aortic valve implantation), since aortic valve disease is a rather common problem in elderly patients, with many of them at high risk for surgery. Similarly, mitral regurgitation is often associated with comorbidities which make surgery high risk. The MitraClip is a promising percutaneous alternative to surgical valve repair or replacement. Other procedures discussed in this review are the percutaneous left atrial appendage closure as a non-pharmacologic therapy to prevent strokes, and renal denervation for resistant hypertension. This review explains the basic principles of these procedures, the most important clinical evidence, and also provides additional recent clinical data on each of these them.

show abstract

Optimal pain management after aortic valve implantation: an opportunity to improve outcomes after transapical access in the future?

Cited by 5 publications

References 11 publications

Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation

Systemic inflammation and oxidative stress contribute to acute kidney injury after transcatheter aortic valve implantation

Almanah 2013: Novel non-coronary cardiac interventions the national society journals present selected research that has driven recent advances in clinical cardiology

Almanac 2013: Novel non-coronary cardiac interventions

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