scholarly journals Heyde syndrome: prevalence and outcomes in patients undergoing transcatheter aortic valve implantation

2021 ◽  
Author(s):  
Lara Waldschmidt ◽  
Andreas Drolz ◽  
Paula Heimburg ◽  
Alina Goßling ◽  
Sebastian Ludwig ◽  
...  
Keyword(s):  
Severe Aortic Stenosis ◽  
Treatment Options ◽  
Bleeding Complications ◽  
Recurrent Bleeding ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
History Of ◽  
Clinical Triad ◽  
One Year ◽  
Valve Implantation

Abstract Background Heyde syndrome (HS) is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. Data on the prevalence of HS and results after TAVI remain scarce. Methods 2548 consecutive patients who underwent TAVI for the treatment of AS from 2008 to 2017 were evaluated for a history of GIB and the presence of HS. The diagnosis of HS was defined as a clinical triad of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. These patients (Heyde) were followed to investigate clinical outcomes, bleeding complications and the recurrence of GIB and were compared to patients with GIB unrelated to HS (Non-Heyde). Results A history of GIB prior to TAVI was detected in 190 patients (7.5%). Among them, 47 patients were diagnosed with HS (1.8%). Heyde patients required blood transfusions more frequently compared to Non-Heyde patients during index hospitalization (50.0% vs. 31.9%, p = 0.03). Recurrent GIB was detected in 39.8% of Heyde compared to 21.2% of Non-Heyde patients one year after TAVI (p = 0.03). In patients diagnosed with HS and recurrent GIB after TAVI, the rate of residual ≥ mild paravalvular leakage (PVL) was higher compared to those without recurrent bleeding (73.3% vs. 38.1%, p = 0.05). Conclusion A relevant number of patients undergoing TAVI were diagnosed with HS. Recurrent GIB was detected in a significant number of Heyde patients during follow-up. A possible association with residual PVL requires further investigation to improve treatment options and outcomes in patients with HS. Graphic abstract

P1848Prevalence and outcomes in patients with Heyde syndrome after transcatheter aortic valve implantation, a single centre experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Waldschmidt ◽  
A Drolz ◽  
P Heimburg ◽  
A Gossling ◽  
N Schofer ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Bleeding Complications ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
History Of ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Introduction Heyde syndrome is known as the association of severe aortic stenosis (AS) and recurrent gastrointestinal bleeding (GIB) from angiodysplasia. To date only few data exist regarding the prevalence of Heyde syndrome and results after transcatheter aortic valve implantation (TAVI) for the treatment of AS. Purpose We sought to evaluate the prevalence of Heyde syndrome in a routine clinical cohort of patients undergoing TAVI and analyze the effectiveness of treatment of AS regarding recurrent GIB in these patients. Methods We conducted a retrospective single-center analysis of 2545 consecutive patients who underwent TAVI for the treatment of AS in 2008–2017. Patients with a history of GIB were identified. The diagnosis of Heyde syndrome was defined as a clinical triad of presence of severe AS, a history of recurrent GIB, and an endoscopic diagnosis of angiodysplasia. GIB of unknown origin or related to other causes was defined as bleeding unrelated to angiodysplasia. Clinical outcomes of patients with Heyde syndrome were evaluated with emphasis on bleeding complications and recurrence of GIB. Results A history of GIB prior to TAVI was detected in 190 patients (7.5%) of the TAVI cohort. Among them, 143 patients had a GIB unrelated to angiodysplasia (5.6%) and 47 patients (1.8%) were diagnosed with Heyde syndrome. Median age and STS-PROM were 80.7 (75.3, 84.0) years and 4.7 (2.7, 9.0) respectively in Heyde patients. TAVI was successfully performed in all cases (66% endovascular access, 34% transapical access). The effective orifice areas increased from 0.8±0.1 cm2 to 2.1±0.5 cm2. Periprocedural major/life-threatening bleeding was found in 6 patients (12.8%), mainly access-related and none due to GIB. In 51% of Heyde-patients transfusion of 4.5±5.7 packed red blood cells was required during the index hospitalisation. During a mean follow-up of 12 months, recurrent GIB after TAVI was detected in 32% of patients with Heyde syndrome. In contrast only 18% of patients with GIB unrelated to angiodysplasia (Non-Heyde) had recurrent GIB after TAVI. In patients diagnosed with Heyde syndrome and recurrent GIB after TAVI the rate of residual mild or moderate paravalvular regurgitation was higher compared to those with an unremarkable course (73% vs. 37%, p=0.045). Figure 1. 1-year Follow-Up Conclusions A relevant number of patients presenting for treatment of AS can be diagnosed with Heyde syndrome. In these patients TAVI can be successfully performed with moderate incidence of periprocedural bleeding complications but significant transfusion rates. Regardless of successful treatment of AS, recurrent GIB was detected in a significant number of Heyde patients during follow-up. The possible association with residual paravalvular regurgitation requires further investigation to improve treatment options in patients with Heyde syndrome.

scholarly journals Prognostic value of a comprehensive geriatric assessment for predicting one-year mortality in presumably frail patient with symptomatic aortic stenosis

2021 ◽  
Author(s):  
Camarzana Audrey ◽  
ANNWEILER Cédric ◽  
PINAUD Frédéric ◽  
ABI-KHALIL Wissam ◽  
ROULEAU Frédéric ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Geriatric Assessment ◽  
Comprehensive Geriatric Assessment ◽  
Severe Aortic Stenosis ◽  
Heart Team ◽  
Frail Patient ◽  
Transcatheter Aortic Valve ◽  
History Of ◽  
One Year ◽  
Valve Implantation

IntroductionDespite of suffering a severe aortic stenosis, some patients are denied from either surgical or Transcatheter Aortic Valve Implantation (TAVI) therapy because of a frail condition. We aim to identify whether a comprehensive geriatric assessment (CGA) might be useful to predict prognosis of presumably frail patients with severe aortic stenosis.Material and methodsBetween March 2011 and July 2016, 818 patients were consecutively and prospectively enrolled. 161 had a CGA and were considered for analysis. Considering combined CGA and Heart team recommendations, 102 TAVI were performed (TAVI group) and 59 patients constituted the no TAVI group. Primary endpoint was all-cause mortality at one year.ResultsThere was no difference between the TAVI and the no TAVI groups considering morphometric data, cardiovascular risk factors or symptoms. The no TAVI group had higher surgical risk (logistic EuroSCORE1 33.4±17.8 vs. 22.7±14.9; p<0.001) and more moderate renal insufficiency (82% vs. 57%; p=0.001). One-year mortality was 16% in the TAVI group and 46% in the no TAVI group (p<0.001). Multivariate analysis revealed history of pulmonary edema, moderate renal failure, and not having a TAVI, to relate to 1-year mortality. There was an interaction of the Five-Times-Sit-to-Stand-Test (FTSST) upon the effect of TAVI on mortality (p=0.049), as FTSST was the only predictor for 1-year mortality in the no TAVI group (HR:0.18 95%CI 0.04–0.76; p=0.019).ConclusionsOne-year mortality was higher in geriatric-assessed frail patient who did not undergo TAVI. FTSST, which assesses patients’ mobility, was the only prognostic marker for 1-year mortality, on top of usual medical parameters.

P3370Prevalence of right ventricular dysfunction according to different parameters: basal and one year after transcatheter aortic valve implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Pardo Sanz ◽  
C Santoro ◽  
R Hinojar ◽  
E Rajjoub ◽  
M Pascual ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Functional Evaluation ◽  
Transcatheter Aortic Valve ◽  
Number Of Patients ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation ◽  
Cutting Point ◽  
Rv Function

Abstract Background Right ventricle (RV) is not often specifically studied in patients with severe aortic stenosis (AS). It's difficult to find the correct tool to assess RV function with echocardiographic parameters, and the percentage of patients with dysfunction may vary depending on the parameter that we use. The aim of the study was to evaluate the prevalence of RV dysfunction basal and one year after transcatheter aortic valve implantation (TAVI), according to different parameters. Methods Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed according to ESC and ASE guidelines. RV dysfunction was assessed using tricuspid annular plane systolic excursion (TAPSE) <17 mm, fractional area change <35%, systolic movement of the RV lateral wall by tissue Doppler imaging (RV-S'TDI) <9.5 cm/s, global longitudinal (RV-GLS) and free wall strain (RV-FWS) using as cutting point [20]. Pre procedure echo, immediate post procedure and 1 year echo were analyzed. Statistical analysis was performed using SSPS version 22. Results The final study population consisted of 78 patients (115 patients were included, 37 were excluded due to suboptimal acoustic window for RV anatomical and functional evaluation), mean age 83.73±6.31 year-old, 38.2% females. We analyzed the percentages of RV dysfunction according to the different parameters evaluated before and in the control one year after. They are shown in Figure 1. Prevalence of RV dysfunction Conclusions The presence of RV dysfunction in patients with severe AS is higher than expected Our data suggest that RV function improve one year after TAVI, in terms of a reduction in the number of patients with dysfunction. The assessment of RV function is difficult, and there is no agreement on what tools are more accurate and useful. RV strain seems to be the most sensible parameter to assess RV function in patients with AS undergoing TAVI. Impact of these measurements in patients management needs further evaluation.

scholarly journals P0709RENAL OUTCOMES AND MORTALITY FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION IN CHRONIC KIDNEY DISEASE PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Amir Shabaka ◽  
Rafael Lucena Valverde ◽  
Andres Escudero ◽  
Gabriela Tirado-Conte ◽  
Luis Nombela Franco
Keyword(s):  
Kidney Disease ◽  
Serum Creatinine ◽  
Kidney Function ◽  
Severe Aortic Stenosis ◽  
Kidney Injury ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation

Abstract Background and Aims Transcatheter aortic valve implantation (TAVI) is indicated for the treatment of patients with severe aortic stenosis with a high surgical risk that are rejected for surgical valve placement. The aim of this study is to evaluate the effect of TAVI on long-term kidney function in stage 3-4 chronic kidney disease (CKD) patients. Method We performed a single-center retrospective observational study of 529 consecutive patients that underwent TAVI between August 2007 and January 2018. We included patients with stage 3 or 4 CKD, with at least two stable measurements of glomerular filtration rate during the three months before TAVI. We excluded patients that presented with an acute kidney injury during the three months that preceded TAVI. Results 165 patients (31.3%) of the patients who underwent TAVI had a stable stage 3 or 4 CKD before implantation. Their mean age was 83.61 ±5.08 years, BMI of 27.79 ± 4.54 kg/m2, baseline serum creatinine of 1.62 ± 0.49 mg/dl for an eGFR measured by MDRD-4 of 40.19 ± 10.79 ml/min, EuroScore-II of 6 (IQR 4-8). 42 patients (28.6%) had a post-procedural acute kidney injury (AKI), 2 of them required temporary renal replacement therapy and 30 patients (71.4%) recovered to their baseline kidney function. Mean contrast media administered was 162.0 ±77.8 ml. Mean serum creatinine decreased from 1.64 ± 0.51 mg/dl to 1.46 ± 0.52 ml/min after 1 year of follow-up (p=0.032). Only 2.4% of patients showed a &gt;50% increase in serum creatinine after 1 year. Median follow-up was 3.8 years (IQR 2.3-5.7 years) during which time no patient progressed to end-stage kidney disease. 33.3 % of patients died during follow-up, with a one-year survival rate of 87% and two-year survival of 82%. Post-interventional major bleeding (14.6 vs 5.8%, p&lt;0.001) and the need for post-interventional pacemaker implantation (25 vs 13.3%, p&lt;0,001)were the only risk factors associated with the development of AKI. Contrast volume was not associated with the development of AKI. AKI was associated with an increased in-hospital stay (13.2 vs 7.4 days, p&lt;0.001), but was not associated with either a reduced kidney function at end of follow-up or an increased mortality (Log-rank X2=1.72, p=0,578). Conclusion Despite the high incidence of post-interventional AKI after TAVI, our study did not show an association between AKI and increased mortality or reduced renal survival. In most cases after AKI patients recovered to their baseline kidney function. There is an improvement in kidney function after one year of treatment of severe aortic stenosis with TAVI in patients with CKD Stage 3-4.

Impact of Pre-procedural Cerebrovascular Events on Clinical Outcomes After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis

2018 ◽  
Vol 24 (5) ◽  
pp. 641-646
Author(s):  
Agata Wiktorowicz ◽  
Pawel Kleczynski ◽  
Artur Dziewierz ◽  
Tomasz Tokarek ◽  
Danuta Sorysz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Vascular Events ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
History Of ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
The Impact

Background: Transcatheter aortic valve implantation (TAVI) is an increasingly common treatment of symptomatic severe aortic valve stenosis (AS). Thus, it is reasonable to carefully investigate the impact of individual clinical factors on outcomes after TAVI. Objectives: We aimed to investigate the impact of the previous cerebro-vascular events (CVEs) on outcomes of patients with severe AS undergoing TAVI. Methods: A total of 148 consecutive patients scheduled for TAVI were included and stratified as with and without a history of CVEs (stroke or transient ischemic attack). Frailty features were also assessed. The primary endpoint was a 12-month all-cause mortality. Results: Seventeen (11.5%) patients had a history of CVEs (the CVE group). At 30 days and 12 months, all-cause mortality was higher in the CVE group [30-day: 5 (29.4%) vs. 7 (5.3%); p=0.005; 12-month: 9 (52.9%) vs. 13 (9.9%); p=0.001]. Similarly, at the longest available follow-up, mortality was higher in the CVE group [10 (58.8%) vs. 23 (17.6%); p=0.001]. Similar rates of other complications after TAVI were noted, apart from inhospital acute kidney injury (AKI) grade 3 [3 (17.6%) vs. 5 (3.8%); p=0.049] and blood transfusions [9 (52.9%) vs. 35 (26.7%); p=0.026]. Results of 5MWT and Katz index assessment indicated a greater level of frailty in the CVE group. There were no differences in subsequent events including CVEs, bleeding, myocardial infarction, and new-onset of atrial fibrillation (AF) at 12 months between the groups. Conclusion: We showed that a history of CVEs in patients with severe AS undergoing TAVI is associated with a higher long-term mortality.

scholarly journals Thromboembolic and Bleeding Complications in Transcatheter Aortic Valve Implantation: Insights on Mechanisms, Prophylaxis and Therapy

2019 ◽  
Vol 8 (2) ◽  
pp. 280 ◽  
Author(s):  
Mark Ranasinghe ◽  
Karlheinz Peter ◽  
James McFadyen
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Bleeding Complications ◽  
Transcatheter Aortic Valve ◽  
Valve Thrombosis ◽  
Haemodynamic Changes ◽  
Thrombotic Complications ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as an important alternative to surgical aortic valve repair (SAVR) for patients with severe aortic stenosis. This rapidly advancing field has produced new-generation devices being delivered with small delivery sheaths, embolic protection devices and improved retrieval features. Despite efforts to reduce the rate of thrombotic complications associated with TAVI, valve thrombosis and cerebral ischaemic events post-TAVI continue to be a significant issue. However, the antithrombotic treatments utilised to prevent these dreaded complications are based on weak evidence and are associated with high rates of bleeding, which in itself is associated with adverse clinical outcomes. Recently, experimental data has shed light on the unique mechanisms, particularly the complex haemodynamic changes at sites of TAVI, that underpin the development of post-TAVI thrombosis. These new insights regarding the drivers of TAVI-associated thrombosis, coupled with the ongoing development of novel antithrombotics which do not cause bleeding, hold the potential to deliver newer, safer therapeutic paradigms to prevent post-TAVI thrombotic and bleeding complications. This review highlights the major challenge of post-TAVI thrombosis and bleeding, and the significant issues surrounding current antithrombotic approaches. Moreover, a detailed discussion regarding the mechanisms of post-TAVI thrombosis is provided, in addition to an appraisal of current antithrombotic guidelines, past and ongoing clinical trials, and how novel therapeutics offer the hope of optimizing antithrombotic strategies and ultimately improving patient outcomes.

Quality-of-life in elderly patients one year after transcatheter aortic valve implantation for severe aortic stenosis

2011 ◽  
Vol 7 (5) ◽  
pp. 573-579 ◽  
Author(s):  
Gian Ussia ◽  
Marco Barbanti ◽  
Valeria Cammalleri ◽  
Marilena Scarabelli ◽  
Massimiliano Mulè ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Elderly Patients ◽  
Severe Aortic Stenosis ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
One Year ◽  
Valve Implantation
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