scholarly journals Use of Pre- and Intensified Postprocedural Physiotherapy in Patients with Symptomatic Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement Study (the 4P-TAVR Study)

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
M. Weber ◽  
U. Klein ◽  
A. Weigert ◽  
W. Schiller ◽  
V. Bayley-Ezziddin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Stay ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Open Heart Surgery ◽  
Intervention Group ◽  
Control Group ◽  
Positive Effects ◽  
Transcatheter Aortic Valve

Background. Physiotherapy prior to open-heart surgery lowers the rate of pneumonia and length of the hospital stay. Pneumonia is a major contributor to short-term mortality following transcatheter aortic valve replacement (TAVR). Hence, we hypothesized that pre- and intensified postprocedural physiotherapy in patients undergoing TAVR might impact the net functional and clinical outcome. Methods and Results. The 4P-TAVR study was a prospective, monocentric, randomized trial. The study was designed to compare the efficacy and safety of intensified periprocedural physiotherapy including inspiratory muscle training versus standard postprocedural physiotherapy. Patients were randomized in a 1 : 1 fashion. 108 patients were included and followed up for 90 days after TAVR. While patients in group A (control group: 50 patients, age: 81.7 ± 5.0 years, 52% male) did not receive physiotherapy prior to TAVR, group B (intervention group: 58 patients, age: 82.2 ± 5.82 years, 47% male) participated in intensive physiotherapy. Compared to the control group, patients in the interventional group showed a lower incidence of postinterventional pneumonia (10 [20.0%] vs. 3 [5.1%], p = 0.016 ) and had a 3-day shorter mean hospital stay (13.5 ± 6.1 days vs. 10.1 ± 4.7 days, p = 0.02 ). The primary composite endpoint of mortality and rehospitalization was not different between the groups. Conclusion. Intensified physiotherapy is safe and has positive effects on clinical outcomes up to 90 days after TAVR but has no impact on the primary combined endpoint of mortality and rehospitalization. Longer follow-up, a multicenter design, and a higher number of subjects are needed to confirm these preliminary results. This trial is registered with DRKS00017239.

Abstract 15732: Transcatheter Aortic Valve Replacement as a Path to Transplant: Similar Short-term Outcomes in Liver and Renal Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Hope Caughron ◽  
Devang Parikh ◽  
Zev Allison ◽  
Vaikom Mahadevan
Keyword(s):  
Renal Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Liver Transplant ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Control Group ◽  
Bleeding Events ◽  
Transcatheter Aortic Valve ◽  
End Stage

Introduction: Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement in patients with predicted poor surgical outcomes due to end stage liver disease (ESLD) or end stage renal disease (ESRD), though there remains minimal data regarding outcomes and treatment strategy in this population. This study evaluates in-hospital, 30-day, and 1-year outcomes after TAVR in a cohort of patients with ESLD and/or ESRD compared to a cohort without these comorbidities. Methods: We retrospectively compared 317 consecutive patients (N=37 ESLD and ESRD, N=286 without ESLD or ESRD) age >18 who underwent transfemoral or transssubclavian TAVR at University of California San Francisco Medical Center from August 1 st , 2014 to April 1 st , 2020. Results: The ESLD and ESRD group had younger patients (69.8±11.5 vs 79.1±9.8, p<0.01), a higher incidence of diabetes mellitus (54.8% vs 28.3%, p<0.01), and higher STS-PROM scores (7.8±6.5 vs 4.7±3.9, p<0.01). Comparing the ESLD and ESRD to the control group, there were similar rates of in-hospital cerebrovascular events (3.2% vs 3.5%, p=0.94), vascular complications (6.5% vs 7.0%, p=0.91), and mortality (0.0%, vs 1.7%, p=0.46) with more bleeding events at discharge (9.7% vs 2.1%, p=0.01) and 1-year (29.2% vs 10.4%, p=0.01). Mortality rates were similar at 30-days (3.2% vs 2.1%, p=0.69) and 6-months (3.4% vs 2.8%, p=0.83), with a trend towards higher mortality in the ESLD and ESRD group at 1-year (16.7% vs 7.8%, p=0.15) from primarily noncardiac causes. Readmission rates were higher in the ESLD and ESRD cohort at 6-months (58.6% vs 27.2%, p<0.01) and 1-year (66.7% vs 40.6%, p=0.02). One patient received dual kidney-liver transplant, 1 patient received a liver transplant, and 8 patients remain on the transplant wait-list. Conclusion: Patients with ESLD and ESRD who underwent TAVR had higher rates of bleeding events and noncardiovascular readmissions with similar rates of mortality at discharge, 30-days, and 6-months when compared to patients without these comorbidities. This study suggests that TAVR may be a safe path to transplant in patients with liver or renal failure and aortic valve pathology, though additional studies are necessary to confirm these findings.

Abstract 16920: Transcatheter Aortic Valve Replacement in Aortic Regurgitation: The U.S. Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chinmy T Jani ◽  
Shilpkumar Arora ◽  
Sopan Lahewala ◽  
ZACHARY ZUZEK ◽  
Rahul Jaswaney ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Vascular Complications ◽  
Paravalvular Leak ◽  
Open Heart ◽  
Transcatheter Aortic Valve

Background: Transcatheter aortic valve replacement (TAVR) may be an effective option for high-risk AR patients. Although international experiences of TAVR for AR are published, U.S. data is limited. The primary objective of this study was to investigate periprocedural and 30-days outcomes in terms of mortality and post-procedural complications in patients undergoing TAVR for AR using large national U.S. databases. Hypothesis: TAVR is a promising option in AR Methods: Study cohorts were derived from Nationwide Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) 2016-17. TAVR and AR were identified using ICD-10-CM-codes. The key outcomes were all-cause mortality, disabling stroke, valvular complications, complete heart block (CHB)/ permanent pacemaker placement (PPM), open heart surgery, acute kidney injury (AKI) requiring dialysis, and vascular complications. Multivariate logistic regression was used to adjust for confounders. Results: 915 patients from the NIS (male-71%, age 65-84.2%) and 822 patients from the NRD (male-69.3%, age 65-80.5%) underwent TAVR for AR. The median length of stay (LOS) was 4 days for both cohorts. In-hospital mortality was 2.7% in NIS and 30-day mortality was 3.3% in NRD. Disabling strokes were noted in 0.6% peri-procedurally and 1.8% at 30-days. Valve-related complications were 18-19% with paravalvular leak being the most common. Approximately 11% of patients developed CHB and/or needed PPM in both cohorts. In NRD, 2.2% of patients required dialysis for AKI, 1.5% developed vascular complications, and 0.6% required open-heart surgery within 30-days post-procedure. Anemia was predictive of increased overall complications and valvular complications, whereas, peripheral vascular disease was predictor of increased valvular complications and CHB/PPM. Conclusion: TAVR is a promising option in AR. Further studies are necessary for the expansion of TAVR as standard treatment in AR.

scholarly journals Prosthetic Valve Endocarditis with Valvular Obstruction after Transcatheter Aortic Valve Replacement

2015 ◽  
Vol 42 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Christine Pabilona ◽  
Bernard Gitler ◽  
Jeffrey A. Lederman ◽  
Donald Miller ◽  
Theodore N. Keltz
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Prosthetic Valve ◽  
Heart Surgery ◽  
Severe Aortic Stenosis ◽  
Open Heart Surgery ◽  
Prosthetic Valve Endocarditis ◽  
Transcatheter Aortic Valve

Patients with severe aortic stenosis who are at high risk for open-heart surgery might be candidates for transcatheter aortic valve replacement (TAVR). To our knowledge, this is the first report of Streptococcus viridans endocarditis that caused prosthetic valve obstruction after TAVR. A 77-year-old man who had undergone TAVR 17 months earlier was admitted because of evidence of prosthetic valve endocarditis. A transthoracic echocardiogram revealed a substantial increase in the transvalvular peak gradient and mean gradient in comparison with an echocardiogram of 7 months earlier. A transesophageal echocardiogram showed a 1.5-cm vegetation obstructing the valve. Blood cultures yielded penicillin-sensitive S. viridans. The patient was hemodynamically stable and was initially treated with vancomycin because of his previous penicillin allergy. Subsequent therapy with levofloxacin, oral penicillin (after a negative penicillin skin test), and intravenous penicillin eliminated the symptoms of the infection. Transcatheter aortic valve replacement is a relatively new procedure, and sequelae are still being discovered. We recommend that physicians consider obstructive endocarditis as one of these.

scholarly journals Clinical Outcome and Safety of Transcaval Access for Transcatheter Aortic Valve Replacement as Compared to Other Alternative Approaches

2021 ◽  
Vol 8 ◽  
Author(s):  
Israel M. Barbash ◽  
Amit Segev ◽  
Anat Berkovitch ◽  
Paul Fefer ◽  
Elad Maor ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Hospital Stay ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Kidney Injury ◽  
Transfemoral Approach ◽  
Entire Cohort ◽  
Transcatheter Aortic Valve ◽  
Artery Disease

Background: A small proportion of patients in need of transcatheter aortic valve replacement (TAVR) are not suitable for the transfemoral approach due to peripheral artery disease. Alternative TAVR approaches are associated with short- and long-term hazards. A novel technique of caval-aortic (transcaval) access for TAVR has been utilized as an alternative access technique.Aim: To compare safety and efficacy of transcaval access as compared to other alternative access (axillary or apical) for TAVR.Methods: A single-center, retrospective analysis of consecutive patients undergoing alternative access for TAVR. Events were adjudicated according to VARC-2 criteria.Results: A total of 185 patients were included in the present analysis. Mean age was 81 years with a small majority for male gender (54%). Of the entire cohort, 20 patients (12%) underwent transcaval TAVR, and 165 patients (82%) underwent TAVR using alternative access. Overall, baseline characteristics were comparable between the two groups. General anesthesia was not utilized in transcaval patients; however, it was routinely used in nearly all alternative access patients. TAVR device success was comparable between the two groups (95%). Acute kidney injury occurred significantly less frequently among transcaval patients as compared to alternative access patients (5 vs. 12%, p = 0.05). Hospital stay was shorter for transcaval patients (6.3 days vs. 14.4; p &lt; 0.001). No difference in early or 30-day mortality (10 vs. 7.9%, p = 0.74) was noted between groups.Conclusions: In patients who cannot undergo TAVR via the trans-femoral approach due to peripheral vascular disease, transcaval access is a safe approach as compared to other alternative access techniques, with lower risk of kidney injury and shorter hospital stay.

Right ventricular function and outcome in patients undergoing transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Matthias Koschutnik ◽  
Varius Dannenberg ◽  
Christian Nitsche ◽  
Carolina Donà ◽  
Jolanta M Siller-Matula ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Right Ventricular ◽  
Hospital Stay ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Heart Failure Hospitalization ◽  
Transcatheter Aortic Valve ◽  
Rv Function

Abstract Aims Right ventricular dysfunction (RVD) on echocardiography has been shown to predict outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, a comparison with the gold standard, RV ejection fraction (EF) on cardiovascular magnetic resonance (CMR), has never been performed. Methods and results Consecutive patients scheduled for TAVR underwent echocardiography and CMR. RV fractional area change (FAC), tricuspid annular plane systolic excursion, RV free-lateral-wall tissue Doppler (S’), and strain were assessed on echocardiography, and RVEF on CMR. Patients were prospectively followed. Adjusted regression analyses were used to report the strength of association per 1-SD decline for each RV function parameter with (i) N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels, (ii) prolonged in-hospital stay (&gt;14 days), and (iii) a composite of heart failure hospitalization and death. Two hundred and four patients (80.9 ± 6.6 y/o; 51% female; EuroSCORE-II: 6.3 ± 5.1%) were included. At a cross-sectional level, all RV function parameters were associated with NT-proBNP levels, but only FAC and RVEF were significantly associated with a prolonged in-hospital stay [adjusted odds ratio 1.86, 95% confidence interval (CI) 1.07–3.21; P = 0.027 and 2.29, 95% CI 1.43–3.67; P = 0.001, respectively]. A total of 56 events occurred during follow-up (mean 13.7 ± 9.5 months). After adjustment for the EuroSCORE-II, only RVEF was significantly associated with the composite endpoint (adjusted hazard ratio 1.70, 95% CI 1.32–2.20; P &lt; 0.001). Conclusion RVD as defined by echocardiography is associated with an advanced disease state but fails to predict outcomes after adjustment for pre-existing clinical risk factors in TAVR patients. In contrast, RVEF on CMR is independently associated with heart failure hospitalization and death.

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