Aortic Valve Gradient and Clinical Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Guy Witberg ◽  
Alon Barsheshet ◽  
Abid Assali ◽  
Hana Vaknin-Assa ◽  
Aviv A. Shaul ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objectives: To explore the relation between the baseline aortic valve gradient (AVG) as a continuous variable and clinical outcomes following transcatheter aortic valve implantation (TAVI) in general and specifically in patients with high-gradient aortic stenosis (AS). Methods: We reviewed 317 consecutive patients who underwent TAVI at our institution. We investigated the relation between AVG as a continuous/categorical variable and outcome among all patients and in patients without low-flow low-gradient AS, using the Cox proportional hazard model adjusting for multiple prognostic variables. Results: Patients had a peak AVG of 79.9 ± 22.8 mm Hg (mean 50.5 ±15.7). During a mean follow-up of 2.7 years, AVG was inversely associated with mortality and mortality or cardiac hospitalization. Every 10-mm-Hg increase in peak AVG was associated with 18% reduction in mortality (p = 0.003) and 19% reduction in mortality/cardiac hospitalization (p < 0.001). Every 10-mm-Hg increase in mean AVG was associated with a 24% reduction in both outcomes (p = 0.005 and p < 0.001). Subgroup analysis of patients with left-ventricular ejection fraction >40% or peak AVG >64 mm Hg yielded similar results. Conclusions: Mean and peak baseline AVGs are directly associated with improved outcomes after TAVI; AVG can be used to select the patients most likely to benefit from TAVI.

scholarly journals Sex and Transcatheter Aortic Valve Implantation: Impact of Female Sex on Clinical Outcomes

2019 ◽  
Vol 14 (3) ◽  
pp. 137-141 ◽  
Author(s):  
Alessandra Laricchia ◽  
Barbara Bellini ◽  
Vittorio Romano ◽  
Saud Khawaja ◽  
Matteo Montorfano ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Factors Affecting ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) has emerged as an alternative treatment for severe symptomatic aortic stenosis in patients who are not suitable for surgery or are at high surgical risk. Approximately 50% of patients undergoing TAVI are female and this is reflected by a higher inclusion rate of women in TAVI trials. However, women undergoing TAVI have different baseline clinical characteristics in comparison to men, with fewer comorbidities and a more preserved left ventricular ejection fraction. This translates into favourable outcomes after TAVI, despite a higher rate of peri-procedural complications. This article discusses gender differences in terms of presentation, procedural characteristics and post-procedural results in patients with aortic stenosis undergoing TAVI, with particular focus on possible sex-specific factors affecting outcome.

scholarly journals 725 Assessment of myocardial work for the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI)

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Isabella Leo ◽  
Jolanda Sabatino ◽  
Antonio Strangio ◽  
Sabrina La Bella ◽  
Sabato Sorrentino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Non Invasive ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims A growing number of patients is undergoing transcatheter treatment of severe Aortic Stenosis. Changes in cardiac mechanics after removal of afterload in these patients are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. Aim of this study was to assess the usefulness of non-invasive MW indices in the clinical assessment of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods and results Consecutive patients with severe aortic stenosis referred for TAVI in a single tertiary centre were included. Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before TAVI and after TAVI to measure myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). Consecutive patients with severe AS (n = 73) undergoing TAVI and matched controls (n = 50) were included. Mean transaortic gradient, AV area, and peak transvalvular velocity were significantly improved (all P &lt; 0.05). No changes in left ventricular ejection fraction nor in global longitudinal strain (GLS) were observed. GWI (P &lt; 0.001) and GCW (P &lt; 0.001) were significantly reduced after TAVI. On the contrary, we observed no significant change in GWW (P = 0.241) nor GWE (P = 0.854). Women had higher GWI (P = 0.007) and GCW (P = 0.014) compared to men, with a larger delta change of GCW. Patients with a low flow low gradient (LF-LG) AS had lower LVEF (P &lt; 0.001), worse GLS (P &lt; 0.001) and lower baseline GWI (P &lt; 0.001), GCW (P &lt; 0.001), and GWE (P = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients. Conclusions The use of non-invasive myocardial work might be useful to further classify patients with AS and could be useful to predict non responders.

scholarly journals Role of monitored anaesthesia care in peri-procedural stroke during unprotected transfemoral aortic valve replacement: A case report

2021 ◽  
Author(s):  
hulya yilmaz ak ◽  
Yasemin Ozsahin ◽  
Kerem Erkalp ◽  
Ziya Salihoglu
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Anaesthesia Care ◽  
Valve Implantation

Abstract: Backgraound: Transcatheter aortic valve implantation (TAVI), with its improved valve technologies will also be an option for patients in the near future and improved operator experience. Cerebrovascular events are among the most feared complications of TAVI, since they cause high morbidity and mortality. Case: After the patient with EuroSCORE II = 8.6% was considered to be at high risk in terms of surgery, the decision to perform TAVI was taken. The valve (Medtronic 26 mm) was successfully placed during the 110 min procedure. Blood loss was 140 mL, no red blood cell (RBC) transfusion and catecholamines requirements were present, no VF (ventricular fibrillation) and cardiac tamponade were observed and post procedure left ventricular ejection fraction (LVEF) was 60%. At the end of the procedure, the BIS value of the patient was 70, regression in the Glasgow Coma Score (GCS = 12), anisocoria in the pupils (R = 2 mm < L = 4 mm) and motor loss in the right arm (3/5) and right leg (3/5) were detected. Modified Rankin scale (mRS) was evaluated as 4. Conclusions: The neurological complication rate of up to 80% during and in the days following the procedure, the long recovery period after embolism, the possibility of being a nursing patient and even the risk of death, remind us that the TAVI procedure and the sedation given during the procedure should never be underestimated. Keywords: Transcatheter aortic valve implantation, cerebral embolism, complications, neuroradiology, monitorized anaesthesia care, aort stenosis.

scholarly journals Does the Presence of Significant Mitral Regurgitation prior to Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact Mortality? – Meta-Analysis and Systematic Review

Cardiology ◽  
2020 ◽  
Vol 145 (7) ◽  
pp. 428-438
Author(s):  
Ankur Sethi ◽  
Vamsi Kodumuri ◽  
Vinoy Prasad ◽  
Ashok Chaudhary ◽  
James Coromilas ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Background: Mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis (AS). However, its independent impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established. Methods: We performed a systematic search for studies reporting characteristics and outcome of patients with and without significant MR and/or adjusted mortality associated with MR post-TAVI. We conducted a meta-analysis of quantitative data. Results: Seventeen studies with 20,717 patients compared outcomes and group characteristics. Twenty-one studies with 32,257 patients reported adjusted odds of mortality associated with MR. Patients with MR were older, had a higher Society of Thoracic Surgeons score, lower left ventricular ejection fraction, a higher incidence of prior myocardial infarction, atrial fibrillation, and a trend towards higher NYHA class III/IV, but had similar mean gradient, gender, and chronic kidney disease. The MR patients had a higher unadjusted short-term (RR = 1.46, 95% CI 1.30–1.65) and long-term mortality (RR = 1.40, 95% CI 1.18–1.65). However, 16 of 21 studies with 27,777 patients found no association between MR and mortality after adjusting for baseline variables. In greater than half of the patients (0.56, 95% CI 0.45–0.66) MR improved by at least one grade following TAVI. Conclusion: The patients with MR undergoing TAVI have a higher burden of risk factors which can independently impact mortality. There is a lack of robust evidence supporting an increased mortality in MR patients, after adjusting for other compounding variables. MR tends to improve in the majority of patients post-TAVI.

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