scholarly journals Patient prosthesis mismatch affects short- and long-term outcomes after aortic valve replacement☆

2006 ◽  
Vol 30 (1) ◽  
pp. 15-19 ◽  
Author(s):  
T WALTHER ◽  
A RASTAN ◽  
V FALK ◽  
S LEHMANN ◽  
J GARBADE ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Long Term Outcomes ◽  
Patient Prosthesis Mismatch ◽  
Short And Long Term

scholarly journals Network Meta-Analysis Comparing the Short and Long-Term Outcomes of Alternative Access for Transcatheter Aortic Valve Replacement

2021 ◽  
Author(s):  
Sagar Ranka ◽  
Shubham Lahan ◽  
Adnan K. Chhatriwalla ◽  
Keith B. Allen ◽  
Sadhika Verma ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
Short And Long Term

AbstractObjectivesThis study aimed to compare short- and long-term outcomes following various alternative access routes for transcatheter aortic valve replacement (TAVR).MethodsThirty-four studies with a pooled sample size of 30,986 records were selected by searching PubMed and Cochrane library databases from inception through 11th June 2021 for patients undergoing TAVR via 1 of 6 different access sites: Transfemoral (TF), Transaortic (TAO), Transapical (TA), Transcarotid (TC), Transaxillary/Subclavian (TSA), and Transcaval (TCV). Data extracted from these studies were used to conduct a frequentist network meta-analysis with a random-effects model using TF access as a reference group.ResultsCompared with TF, both TAO [RR 1.91, 95% CI (1.46–2.50)] and TA access [RR 2.12, 95%CI (1.84–2.46)] were associated with an increased risk of 30-day mortality. No significant difference was observed for stroke, myocardial infarction, major bleeding, conversion to open surgery, and major adverse cardiovascular or cerebrovascular events in the short-term (≤ 30 days). Major vascular complications were lower in TA [RR 0.43, (95% CI, 0.28-0.67)] and TC [RR 0.51, 95% CI (0.35-0.73)] access compared to TF. The 1-year mortality was higher in the TAO [RR of 1.35, (95% CI, 1.01–1.81)] and TA [RR 1.44, (95% CI, 1.14–1.81)] groups.ConclusionNon-thoracic alternative access site utilization for TAVR implantation (TC, TSA and TCV) is associated with similar outcomes to conventional TF access. Thoracic TAVR access (TAO and TA) is associated with increased short and long-term mortality.

Abstract 12876: Impact of Anesthesia Type on Short- and Long-term Outcomes After Transcatheter Aortic Valve Replacement: The Cleveland Clinic Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yasser Sammour ◽  
Jimmy L Kerrigan ◽  
Rama D Gajulapalli ◽  
Kinjal Banerjee ◽  
Sanchit Chawla ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Long Term Outcomes ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
The Mean

Introduction: The early approach was to perform transcatheter aortic valve replacement (TAVR) under general anesthesia (GA). Over time, monitored anesthesia care (MAC) has been introduced as a less invasive option to facilitate TAVR. Objective: We sought to compare short- and long-term outcomes between TAVR patients undergoing GA versus those receiving MAC. Methods: We identified all consecutive patients with severe symptomatic aortic stenosis who underwent Transfemoral (TF)-TAVR at our institution between January 2012 and April 2017. Results: We included 998 patients who met our inclusion criteria. Overall, the mean age was 80.4 ± 9.7 years, 57.4% were males and 95.2% were Caucasians. MAC was used in 43.9%. The mean STS risk score (SD) was lower with MAC (6.7 ± 4.3% vs. 7.6 ± 4.5%; p = 0.004). MAC was associated with lower all-cause mortality at both 30 days (0.5% vs. 4.2%; log-rank p < 0.001), and 1 year (11.7% vs. 16%; log-rank p = 0.024). However, this difference was negated at 3 years (37% vs. 39%; log-rank p = 0.271). Further, there were no differences in major adverse cardiac and cerebrovascular events (MACCE) at either 30 days (4.6% vs. 7.6%; log-rank p = 0.089) or 1 year (21.5% vs. 24.2%; log-rank p = 0.242). There were no differences in the rates of myocardial infarction (1.6% vs. 0.9%; log-rank p = 0.375), stroke or transient ischemic attacks (3.1% vs. 3.4%; log-rank p = 0.817) or heart failure hospitalizations (9.6% vs. 9.5%; log-rank p = 0.815) at 1 year. In multivariate analysis, MAC predicted lower all-cause death at 1 year after TAVR (HR 0.672; 95% CI 0.453 - 0.996; p = 0.048) but not at 3 years (HR 0.882 (0.705 - 1.103; p = 0.271). MAC was not an independent predictor of MACCE (HR 0.851; 95% CI 0.643 - 1.126; p = 0.258). Conclusions: Compared to GA, MAC was associated with lower all-cause mortality at both 30 days and 1 year, but not at 3 years. There were no differences in MACCE between the two groups at either 30 days or 1 year.

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