Risk Assessment in Patient Selection for Transcatheter Aortic Valve Replacement

Walsh, Joseph; Teirstein, Paul S.; Stinis, Curtiss T.; Price, Matthew J.

doi:10.1016/j.iccl.2014.09.001

Cited by 3 publications

(3 citation statements)

References 48 publications

(46 reference statements)

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“…Previous studies have demonstrated a multitude of clinical risk factors associated with poor outcomes following TAVR 5 . However, there is a lack of data investigating risk factors of post‐TAVR mortality in patients with left ventricular systolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have demonstrated a multitude of clinical risk factors associated with poor outcomes following TAVR. 5 However, there is a lack of data investigating risk factors of post-TAVR mortality in patients with left ventricular systolic dysfunction. Accurate risk stratification models and clear therapeutic strategies for these cohorts remain unknown when compared to those with preserved ejection fraction.…”

Section: Risk Factors Of Mortality Following Tavrmentioning

confidence: 99%

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Risk assessment in patients with left ventricular systolic dysfunction following transcatheter aortic valve replacement

Imamura

Ueno

Sobajima

et al. 2021

Journal of Cardiac Surgery

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Background: Mortality following transcatheter aortic valve replacement (TAVR) in patients with post-procedural left ventricular systolic dysfunction remains high. We investigated clinical variables associating with worse clinical outcomes following TAVR in patients with systolic dysfunction.Methods: We retrospectively investigated 2588 patients with severe aortic stenosis who received TAVR and were enrolled in the optimized transcatheter valvular intervention (OCEAN-TAVI) multicenter registry (UMIN000020423). The association between the clinical variables following TAVR and 2-year cardiovascular mortality was investigated among those with post-TAVR left ventricular ejection fraction less than 50%.

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Section: Discussionmentioning

confidence: 99%

Section: Risk Factors Of Mortality Following Tavrmentioning

confidence: 99%

Risk assessment in patients with left ventricular systolic dysfunction following transcatheter aortic valve replacement

Imamura

Ueno

Sobajima

et al. 2021

Journal of Cardiac Surgery

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“…Demographic factors including age, sex, and race were also assessed as independent risk factors for morbidity and mortality. The findings of this study will guide the evaluation of strategies aimed at reducing the incidence of perioperative stroke following TAVI through preoperative screening, 10 intraoperative identification, 11 12 and intensive medical management. 13 …”

Section: Introductionmentioning

confidence: 94%

Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study

et al. 2017

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Background and PurposePerioperative stroke is a significant complication of transcatheter aortic valve implantation (TAVI). This study aimed to quantify perioperative stroke as an independent risk factor for in-hospital mortality and postoperative morbidity in patients receiving TAVI.MethodsA retrospective cohort study was conducted using the National Inpatient Sample. Patients undergoing TAVI during 2012 and 2013 were identified using diagnostic codes of International Classification of Diseases, ninth revision. Univariate and multivariate analyses were performed using patient demographics and comorbidities to identify predictors of mortality and morbidity, defined by a length of stay of >14 days and/or discharge to a place other than home.ResultsData were obtained from 7,556 patients undergoing TAVI during 2012 and 2013. The incidence rates of mortality and morbidity were 4.57 and 71.12%, respectively. Perioperative stroke was an independent risk factor for mortality [odds ratio (OR)=3.182, 95% confidence interval (CI)=1.530–6.618, p=0.002], as were infection (OR=17.899, 95% CI=9.876–32.440, p<0.001) and pericardial tamponade (OR=7.272, 95% CI=2.874–18.402, p<0.001). Stroke also predicted morbidity (OR=5.223, 95% CI=2.005–13.608, p=0.001), which was also associated with age, being female, being Asian, moderate and high Van Walraven scores (VWR), and infection.ConclusionsIn conclusion, perioperative stroke was found to be independently associated with in-hospital mortality and postoperative morbidity, as are age and high VWR. Our findings support the use of further preoperative, intraoperative, and postoperative management strategies during TAVI.

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Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image‐Based Patient‐Specific In Silico Modeling

Keshavarz‐Motamed

Khodaei

Nezami

et al. 2020

JAHA

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Background Mixed valvular disease (MVD), mitral regurgitation (MR) from pre‐existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre‐existing MVD, PVL, LV, and post‐TAVR recovery is meager. Methods and Results We quantified the effects of MVD on valvular‐ventricular hemodynamics using an image‐based patient‐specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P <0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post‐TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post‐TAVR. MR worsened in 32 patients post‐TAVR and did not improve in 18 other patients. Conclusions PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post‐TAVR, most MVD patients (75% of N=72; P <0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre‐existing MR condition (60% of N=48; P <0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.

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Risk Assessment in Patient Selection for Transcatheter Aortic Valve Replacement

Cited by 3 publications

References 48 publications

Risk assessment in patients with left ventricular systolic dysfunction following transcatheter aortic valve replacement

Risk assessment in patients with left ventricular systolic dysfunction following transcatheter aortic valve replacement

Perioperative Stroke, In-Hospital Mortality, and Postoperative Morbidity Following Transcatheter Aortic Valve Implantation: A Nationwide Study

Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image‐Based Patient‐Specific In Silico Modeling

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