Quality of life assessment after percutaneous aortic valve implantation

Ussia, Gian Paolo; Mulè, Massimiliano; Barbanti, Marco; Scarabelli, Marilena; Immè, Sebastiano; Capodanno, Davide; Ciriminna, Saverio; Tamburino, Corrado

doi:10.1093/eurheartj/ehp171

Cited by 83 publications

(42 citation statements)

References 19 publications

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“…21,22 Quality of life is an important clinical outcome measure and is 1 of the main reasons that TAVI is conducted. 23 As such, anything negatively affecting HRQoL, such by guest on May 11, 2018 http://circinterventions.ahajournals.org/ Downloaded from as silent cerebral emboli, would be of concern. This study has shown that for both TAVI and SAVR new cerebral emboli did not detrimentally affect patient-reported HRQoL at 6 months.…”

Section: Discussionmentioning

confidence: 99%

Consequence of Cerebral Embolism After Transcatheter Aortic Valve Implantation Compared With Contemporary Surgical Aortic Valve Replacement

Uddin

Fairbairn

Djoukhader

et al. 2015

Circ: Cardiovascular Interventions

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T ranscatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis is an alternative to medical therapy or surgical aortic valve replacement (SAVR) in those at high surgical risk.1 TAVI has been shown to reduce mortality and improve patient symptoms and healthrelated quality of life (HRQoL).2,3 Although TAVI seems cost-effective when compared with SAVR, embolic cerebral infarction remains a concern because of its frequency and the associated morbidity, mortality, and healthcare costs. 4 This will be increasingly important if TAVI is considered for lower risk or younger patient populations.Previous work has shown that embolic cerebral infarction occurs after both TAVI and SAVR, with the majority remaining subclinical.3,5-9 The incidence of cerebral emboli seems to be greater post TAVI, with no significant difference between the access routes (transfemoral versus transapical) or valve types (Medtronic CoreValve versus Edwards Sapien). 8 The clinical consequences of these silent infarcts and identification of risk factors are yet to be fully established. Two studies have assessed basic cerebral function using a mini-mental state examination pre and post TAVI, demonstrating no significant change at 3 months. 5,6 We Background-Incidence of cerebral microinfarcts is higher after transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR). It is unknown whether these lesions persist and what direct impact they have on health-related quality of life. The objective was to identify predictors of cerebral microinfarction and measure their effect on health-related quality of life during 6 months after TAVI when compared with SAVR. Methods and Results-Cerebral MRI was conducted at baseline, post procedure, and 6 months using diffusion-weighted imaging. Health-related quality of life was measured at baseline, 30 days, and 6 months with short form-12 health outcomes and EuroQol 5 dimensions questionnaires. One hundred eleven patients (TAVI, n=71; SAVR, n=40) were studied.

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Section: Discussionmentioning

confidence: 99%

Consequence of Cerebral Embolism After Transcatheter Aortic Valve Implantation Compared With Contemporary Surgical Aortic Valve Replacement

Uddin

Fairbairn

Djoukhader

et al. 2015

Circ: Cardiovascular Interventions

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“…The CoreValve prosthesis improves hemodynamic aortic valve function and results in an improvement in both quality of life and mortality. 8,27,28 The study patients received the CoreValve device, first used in a human by Grube et al 29 in 2005. It consists of a bioprosthetic valve (derived from porcine pericardium) mounted and sutured within a laser-cut nitinol frame.…”

Section: Discussionmentioning

confidence: 99%

Permanent Pacemaker Insertion After CoreValve Transcatheter Aortic Valve Implantation

Khawaja¹,

Rajani²,

Cook³

et al. 2011

Circulation

293

159

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Background-Permanent pacemaker (PPM) requirement is a recognized complication of transcatheter aortic valve implantation. We assessed the UK incidence of permanent pacing within 30 days of CoreValve implantation and formulated an anatomic and electrophysiological model. Methods and Results-Data from 270 patients at 10 centers in the United Kingdom were examined. Twenty-five patients (8%) had preexisting PPMs; 2 patients had incomplete data. The remaining 243 were 81.3Ϯ6.7 years of age; 50.6% were male. QRS duration increased from 105Ϯ23 to 135Ϯ29 milliseconds (PϽ0.01). Left bundle-branch block incidence was 13% at baseline and 61% after the procedure (PϽ0.001). Eighty-one patients (33.3%) required a PPM within 30 days.Rates of pacing according to preexisting ECG abnormalities were as follows: right bundle-branch block, 65.2%; left bundle-branch block, 43.75%; normal QRS, 27.6%. Among patients who required PPM implantation, the median time to insertion was 4.0 days (interquartile range, 2.0 to 7.75 days). Multivariable analysis revealed that periprocedural atrioventricular block (odds ratio, 6.29; 95% confidence interval, 3.55 to 11.15), balloon predilatation (odds ratio, 2.68; 95% confidence interval, 2.00 to 3.47), use of the larger (29 mm) CoreValve prosthesis (odds ratio, 2.50; 95% confidence interval, 1.22 to 5.11), interventricular septum diameter (odds ratio, 1.18; 95% confidence interval, 1.10 to 3.06), and prolonged QRS duration (odds ratio, 3.45; 95% confidence interval, 1.61 to 7.40) were independently associated with the need for PPM. Conclusion-One third of patients undergoing a CoreValve transcatheter aortic valve implantation procedure require a PPM within 30 days. Periprocedural atrioventricular block, balloon predilatation, use of the larger CoreValve prosthesis, increased interventricular septum diameter and prolonged QRS duration were associated with the need for PPM. (Circulation. 2011;123:951-960.)Key Words: aortic stenosis Ⅲ electrocardiography Ⅲ pacemakers Ⅲ transcatheter aortic valve Ⅲ transcatheter aortic valve implantation A ortic stenosis (AS) is the most common valvular disease in Europe, 1,2 and age is a significant factor in its natural history. 2 Severe AS occurs in 2% to 4% of adults Ͼ65 years of age. 3,4 Current guidelines recommend aortic valve replacement (AVR) surgery for these patients when they become symptomatic or develop impaired left ventricular systolic function with an ejection fraction Ͻ50%. 5,6 However, the aging population generates greater numbers of patients with severe AS and significant comorbidities, 3 prohibitively raising their perioperative risks for surgical AVR. Since the first successful implant in 2002,7 transcatheter aortic valve implantation (TAVI) has become an increasingly common technology in this cohort. The initial surveillance has been encouraging with respect to procedural success, improvement in quality of life, and short-term and medium-term mortality. 8 -10 Clinical Perspective on p 960Aortic valvular disease is itself associated with cond...

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“…12). The encouraging mid-and long-term results of this technique, together with increased patient comfort, shortened intensive care and hospital stay, and the avoidance of cardiopulmonary bypass, make this non-surgical technique extremely appealing (Ussia et al, 2009). …”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

“…Device sizing and positioning are the main challenges, but vascular complications, electrical conduction abnormalities and post-procedural aortic regurgitation still remain major safety concerns. In addition, according to the current position statement, TAVI is indicated only in patients with severe symptomatic aortic stenosis, and who are considered at high or prohibitive risk for conventional surgery (Ussia et al, 2009.…”

Section: Transcatheter Aortic Valve Implantationmentioning

confidence: 99%

Finite Element Analysis to Study Percutaneous Heart Valves

Schievano¹,

Capelli²,

Cosentino³

et al. 2012

Finite Element Analysis - From Biomedical Applications to Industrial Developments

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Quality of life assessment after percutaneous aortic valve implantation

Abstract: Our preliminary results show a marked short-term improvement in functional status and physical and mental health in patients underwent PAVI.

Cited by 83 publications

References 19 publications

Consequence of Cerebral Embolism After Transcatheter Aortic Valve Implantation Compared With Contemporary Surgical Aortic Valve Replacement

Consequence of Cerebral Embolism After Transcatheter Aortic Valve Implantation Compared With Contemporary Surgical Aortic Valve Replacement

Permanent Pacemaker Insertion After CoreValve Transcatheter Aortic Valve Implantation

Finite Element Analysis to Study Percutaneous Heart Valves

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