Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure

Jalava, Maina P.; Laakso, Teemu; Virtanen, Marko; Niemelä, Matti; Ahvenvaara, Tuomas; Tauriainen, Tuomas; Maaranen, Pasi; Husso, Annastiina; Kinnunen, Esko; Dahlbacka, Sebastian; Jaakkola, Samuli; Airaksinen, Juhani; Anttila, Vesa; Rosato, Stefano; D’Errigo, Paola; Savontaus, Mikko; Laine, Mika; Mäkikallio, Timo H.; Valtola, Antti; Raivio, Peter; Eskola, Markku; Biancari, Fausto

doi:10.1016/j.athoracsur.2019.05.044

Cited by 18 publications

(21 citation statements)

References 21 publications

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“…It is responsible for about $108 billion per year, or 1–3%, of global health expenditures 1 . For aortic stenosis patients, heart failure is the primary cause of death, and half of them will die within two years of symptom onset if aortic valve disease is left untreated 2 . Prior hospitalization due to heart failure is associated with poor outcomes following aortic stenosis intervention; some research suggests that by performing an earlier treatment, before patients experience hospitalization for heart failure, outcomes may be improved 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Khodaei

Henstock

Sadeghi

et al. 2021

Sci Rep

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One of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.

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Section: Introductionmentioning

confidence: 99%

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Khodaei

Henstock

Sadeghi

et al. 2021

Sci Rep

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“…Among adults with severe aortic stenosis (AS) who are scheduled to undergo surgical (SAVR) or transcatheter aortic valve replacement (TAVR), a substantial proportion is hospitalized with heart failure (HF) in the weeks preceding the procedure 1,2 . In Ontario, Canada, 12% of patients referred for TAVR were hospitalized for HF within a median of 80 days wait time 1 .…”

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confidence: 99%

“…In Ontario, Canada, 12% of patients referred for TAVR were hospitalized for HF within a median of 80 days wait time 1 . Similarly, in the FinnValve registry, 11% of patients waiting for TAVR or SAVR developed acute HF within 60 days prior to the procedure 2 …”

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confidence: 99%

“…Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS 2,6,7 . In the FinnValve registry, recent acute HF was associated with lower 30‐day and 5‐year survival, more post‐procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups 2 . Similarly, in a retrospective cohort from France, TAVR recipients presenting with acute HF had more post‐procedural acute renal failure and requirement for inotropic support, and significantly higher mortality both at 30 days (10% vs. 5%, P = 0.02) and at 1 year (27% vs. 15%, P < 0.001) compared to stable patients 7 .…”

mentioning

confidence: 99%

“…Patients with AS who develop HF have suboptimal outcomes after TAVR or SAVR compared to their non‐HF counterparts 3–5 . Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS 2,6,7 . In the FinnValve registry, recent acute HF was associated with lower 30‐day and 5‐year survival, more post‐procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups 2 .…”

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confidence: 99%

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Transcatheter aortic valve replacement after heart failure hospitalization: too little, too late?

Parikh

Tsigkas

Kalogeropoulos

2020

European J of Heart Fail

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This article refers to 'Impact of recent heart failure hospitalization on clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement: an analysis from the PARTNER 2 trial and registries' by S. Chen et al., published in this issue on pages 1866-1874. Among adults with severe aortic stenosis (AS) who are scheduled to undergo surgical (SAVR) or transcatheter aortic valve replacement (TAVR), a substantial proportion is hospitalized with heart failure (HF) in the weeks preceding the procedure. 1,2 In Ontario, Canada, 12% of patients referred for TAVR were hospitalized for HF within a median of 80 days wait time. 1 Similarly, in the FinnValve registry, 11% of patients waiting for TAVR or SAVR developed acute HF within 60 days prior to the procedure. 2 Patients with AS who develop HF have suboptimal outcomes after TAVR or SAVR compared to their non-HF counterparts. 3-5 Acute HF at presentation in TAVR or SAVR candidates is associated with even worse prognosis despite correction of AS. 2,6,7 In the FinnValve registry, recent acute HF was associated with lower 30-day and 5-year survival, more post-procedural complications (including acute renal failure), and higher rates of healthcare resource utilization in both the SAVR and TAVR groups. 2 Similarly, in a retrospective cohort from France, TAVR recipients presenting with acute HF had more post-procedural acute renal failure and requirement for inotropic support, and significantly higher mortality both at 30 days (10% vs. 5%, P = 0.02) and at 1 year (27% vs. 15%, P < 0.001) compared to stable patients. 7 Importantly, acute HF was widely prevalent (>50%) in patients with AS on the TAVR waitlist who were untreated. 7 This finding is consistent with contemporary reports of high rates of hospitalization for HF among untreated patients with AS. 8 In this issue of the Journal, Chen and colleagues provide additional insights into the impact of acute HF on the clinical outcomes of intermediate-to-high or prohibitive surgical risk patients undergoing TAVR for severe symptomatic AS. 9 The investigators The opinions expressed in this article are not necessarily those of the Editors of the European Journal of Heart Failure or of the European Society of Cardiology.

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Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement

Zamorano

Appleby

Benamer

et al. 2023

Cathet Cardio Intervent

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Transcatheter aortic valve implantation (TAVI) is recommended for a growing range of patients with severe aortic stenosis in the European Society of Cardiology and European Association for Cardio‐Thoracic Surgery (ESC/EACTS) 2021 Guidelines update. However, guideline implementation programs are needed to ensure the application of clinical recommendations which will favorably influence disease outcomes. An Expert Council was convened to identify whether cardiology services across Europe are set up to address the growing needs of patients with severe aortic stenosis for increased access to TAVI by identifying the key challenges faced in growing TAVI programs and mapping associated solutions. Wide variation exists across Europe in terms of TAVI availability and capacity to deliver the increased demand for TAVI in different countries. The recommendations of this Expert Council focus on the short‐to‐medium‐term aspects where the most immediate, actionable impact can be achieved. The focus on improving procedural efficiency and optimizing the patient pathway via clinical practice and patient management demonstrates how to mitigate the current major issues of shortfall in catheterization laboratory, workforce, and bed capacity. Procedural efficiencies may be achieved through steps including streamlined patient assessment, the benchmarking of standards for minimalist procedures, standardized approaches around patient monitoring and conduction issues, and the implementation of nurse specialists and dedicated TAVI coordinators to manage organization, logistics, and early mobilization. Increased collaboration with wider stakeholders within institutions will support successful TAVI uptake and improve patient and economic outcomes. Further, increased education, collaboration, and partnership between cardiology centers will facilitate sharing of expertise and best clinical practice.

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Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure

Cited by 18 publications

References 21 publications

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

Transcatheter aortic valve replacement after heart failure hospitalization: too little, too late?

Improving access to transcatheter aortic valve implantation across Europe by restructuring cardiovascular services: An expert council consensus statement

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