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Transcatheter versus surgical aortic valve replacement in severe, symptomatic aortic stenosis

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Journal of Geriatric Cardiology 2018年第1期15卷 76-85页

作者： Tsigkas Grigorios Despotopoulos Stefanos Makris Athanasios Koniari Ioanna Armylagos Stylianos Davlouros Periklis Hahalis George Department of Cardiology Medical School University of Patras Patras Greece

aortic stenosis （AS） is the most common type of valvular heart disease in the elderly. Surgical aortic valve replacement （SAVR） has been the standard practice for treating severe, symptomatic AS, but recently new treatment options have emerged, Transcatheter aortic valve replacement （TAVR） is now an established treatment option in patients at high surgical risk. In this review, we focus on recent developments and compare the two treatment methods in specific populations in terms of efficacy and safety （e.g., in patients with history of prior thoracic surgery, type of anesthesia employed, access site used or need for permanent pacing）. The impact of comorbidities （pulmonary hypertension, arterial hypertension and obesity paradox）, the cost-effectiveness of TAVR vs. SAVR and advances in transcatheter valve technology as well as issues that merit further investigation are further discussed. Moreover, outcomes and complications of TAVR in patients of different risk category （extremely high, high, intermediate and low risk） are analyzed. We strongly believe that during the following years, TAVR may evolve as the treatment of choice in a broader group of patients with symptomatic AS and beyond those with intermediate and high-risk features.

关键词： aortic stenosis aortic valve replacement Stent valve Transcatheter aortic valve replacement

Change in quality of life after transcatheter aortic valve implantation and aortic valve replacement surgery in Australian patients aged ≥ 75 years： the effects of EuroSCORE and patient operability

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Journal of Geriatric Cardiology 2015年第1期12卷 30-36页

作者： Phillip J. Tully Prakash Roshan Greg D Rice Ajay Sinhal Jayme S Bennetts Robert A Baker Cardiac Surgery Research Department of Surgery School of Medicine Flinders University of South Australia Bedford Park 5042 Australia Freemasons Foundation Centre for Men 's Health Discipline of Medicine School of Medicine University of Adelaide North Terrace Adelaide 5005 Australia brd Park 5042 Australia Department of Cardiac and Thoracic Surgery Flinders Medical Centre Level 6 Flinders Private Hospital Bedford Park 5042 Australia

Objective To determine the extent to which differences in generic quality of life （QOL） between transcatheter aortic valve implanta- tion （TAVI） and surgical aortic valve replacement （AVR） patients explained by EuroSCORE and heart-team operability assessment. Methods A total of 146 high-risk patients with EuroSCORE 〉 6 and aged 〉 75 years underwent TAVI （n = 80） or aortic valve replacement （n = 66） between February 2010 and July 2013. A total of 75 patients also completed preoperative and six month SF-12 QOL measures. Analyses examined incident major morbidity, compared six month QOL between groups adjusted for EUroSCORE and operability, and quantified rates of clinically significant QOL improvement and deterioration. Results The AVR group required longer ventilation （〉 24 h）（TAVI 5.0% vs. AVR 20.6%, P = 0.004） and more units of red blood cells [TAVI 0 （0-1） vs. AVR 2 （0-3）, P = 0.01]. New renal failure was higher in TAVI （TAVI 5.0% vs. AVR 0%, P = 0.06）. TAVI patients reported significantly lower vitality （P = 0.01） by comparison to AVR patients, however these findings were no longer significant after adjustment for operability. In both procedures, clinically significant QOL improvement was common [range 25.0% （general health） - 62.9% （physical role）] whereas deterioration in QOL occurred less frequently [range 9.3% （physical role） - 33.3% （mental health）]. Conclusions Clinically significant improvement and deterioration in QOL was evident at six months in high risk elderly aortic valve replacement patients. Overall QOL did not differ between TAVI and AVR once operability was taken into consideration.

关键词： aortic valve replacement Cardiac surgery EuroSCORE Transcatheter aortic valve implantation Quality of life

Risk scoring model for prediction of non-home discharge after transcatheter aortic valve replacement

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Journal of Geriatric Cardiology 2020年第10期17卷 621-627页

作者： Alexis K Okoh Ebru Ozturk Justin Gold Emaad Siddiqui Nehal Dhaduk Bruce Haik Chun-Guang CHEN Marc Cohen Mark J Russo Cardiovascular Outcomes Research Institute RWJ Barnabas Health-NBIMCNewarkNew JerseyUSA Department of Medicine Division of BiostatisticsHacettepe UniversityAnkaraTurkey Rutgers New Jersey Medical School NewarkNew JerseyUSA Department of Surgery Division of Cardiothoracic SurgeryRutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA

Background Patients undergoing transcatheter aortic valve replacement(TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge after TAVR. Methods Patients discharged alive after TAVR at three centers were identified from a prospectively maintained database randomly divided into 80% derivation and 20% validation cohorts. Logistic regression models were fit to identify preoperative factors associated with non-home discharge in the derivation cohort. Multivariable models were developed and a nomogram based risk-scoring system was developed for use in preoperative counseling. Results Between June 2012 and December 2018, a total of 1,163 patients had TAVR at three centers. Thirty-seven patients who died before discharge were excluded. Of the remaining 1,126 patients(97%) who were discharged alive, the incidence of non-home discharge was 25.6%(n = 289). The patient population was randomly divided into the 80%(n = 900) derivation cohort and 20%(n = 226) validation cohort. Mean ± SD age of the study population was 83 ± 8 years. In multivariable analysis, factors that were significantly associated with non-home discharge were extreme age, female sex, higher STS scores, use of general anesthesia, elective procedures, chronic liver disease, non-transfemoral approach and postoperative complications. The unbiased estimate of the C-index was 0.81 and the model had excellent calibration. Conclusions One out of every four patients undergoing TAVR is discharged to a location other than home. Identification of preoperative factors associated with non-home discharge can assist patient counseling and postoperative disposition planning.

关键词： aortic valve replacement Non-home discharge Postoperative risk Transcatheter Transfemoral

Machine Learning Prediction Models of Optimal Time for aortic valve replacement in Asymptomatic Patients

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Intelligent Automation & Soft Computing 2023年第7期37卷 455-470页

作者： Salah Alzghoul Othman Smadi Ali Al Bataineh Mamon Hatmal Ahmad Alamm Biomedical Engineering Department The Hashemite UniversityZarqaJordan Department of Electrical and Computer Engineering Norwich UniversityNorthfieldVermont05663USA Department of Biochemistry and Molecular Biology The Hashemite UniversityZarqaJordan National Centre for Big Data Science and Artificial Intelligence AmmanJordan

Currently,the decision of aortic valve replacement surgery time for asymptomatic patients with moderate-to-severe aortic stenosis(AS)is made by healthcare professionals based on the patient’s clinical biometric records.A delay in surgical aortic valve replacement(SAVR)can potentially affect patients’quality of *** using ML algorithms,this study aims to predict the optimal SAVR timing and determine the enhancement in moderate-to-severe AS patient survival following *** study represents a novel approach that has the potential to improve decision-making and,ultimately,improve patient *** analyze data from 176 patients with moderate-to-severe aortic stenosis who had undergone or were indicated for *** divide the data into two groups:those who died within the first year after SAVR and those who survived for more than one year or were still alive at the last *** then use six different ML algorithms,Support Vector Machine(SVM),Classification and Regression Tree(C and R tree),Generalized Linear(GL),Chi-Square Automatic Interaction Detector(CHAID),Artificial Neural Net-work(ANN),and Linear Regression(LR),to generate predictions for the best timing for *** results showed that the SVM algorithm is the best model for predicting the optimal timing for SAVR and for predicting the post-surgery survival *** optimizing the timing of SAVR surgery using the SVM algorithm,we observed a significant improvement in the survival period after *** study demonstrates that ML algorithms generate reliable models for predicting the optimal timing of SAVR in asymptomatic patients with moderate-to-severe AS.

关键词： aortic stenosis aortic valve replacement machine learning survival period enhancement artificial intelligence in cardiology

Feasibility and clinical outcomes in nonagenarians undergoing transcatheter aortic valve replacement with the LOTUSTM valve

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Journal of Geriatric Cardiology 2016年第7期13卷 636-638页

作者： Satish Ramkumar Hashrul N Rashid Sarah Zaman Liam McCormick Robert Gooley Damon Jackson Ian T Meredith MonashHEART Monash Health Melbourne Victoria Australia Monash Cardiovascular Research Centre Monash University Melbourne Victoria Australia

Surgical aortic valve replacement （AVR） is associated with very high peri-operative risk in the nonagenarian populationflI Patients with severe aortic stenosis treated conservatively have high rates of mortality with poor quality of life and loss of independence. Transcatheter aortic valve replacement （TAVR） has been validated in the high risk elderly population as a viable alternative to surgery with comparable outcomes.

关键词： aortic valve replacement Nonagenarian patients Transcatheter aortic valve replacement

Importance of concomitant functional mitral regurgitation on survival in severe aortic stenosis patients undergoing aortic valve replacement

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World Journal of Cardiology 2023年第5期15卷 253-261页

作者： Ramdas G Pai Padmini Varadarajan Department of Cardiology University of California Riverside School of MedicineRiverside/St.Bernardine Medical CenterSan BernardinoRiversideCA 92521United States Department of Cardiology University of California Riverside School of MedicineRiversideCA 92521United States

BACKGROUND Mitral regurgitation(MR)is commonly seen in patients with severe aortic stenosis(AS)undergoing aortic valve replacement(AVR).But the long-term implications of MR in AS are *** To investigate MR’s impact on survival of patients undergoing surgical AVR for severe *** Of the 740 consecutive patients with severe AS evaluated between 1993 and 2003,287 underwent AVR forming the study *** were followed up to death or till the end of *** reviews were performed for clinical,echocardiographic,and therapeutic *** was graded on a 1-4 *** data was obtained from chart review and the Social Security Death *** was analyzed as a function of degree of *** The mean age of the severe AS patients who had AVR(n=287)was 72±13 years,46%*** up to 26 years of follow up,there were 201(70%)deaths,giving deep insights into the determinants of survival of severe AS who had *** 5,10 and 20 years survival rates were 75%,45%and 25%*** of MR was associated with higher mortality in a graded fashion(P=0.0003).MR was significantly associated with lower left ventricular(LV)ejection fraction and larger LV *** of MR on mortality was partially mediated through lower LV ejection fraction and larger LV *** Cox regression,MR,lower ejection fraction(EF)and larger LV end-systolic dimension were independent predictors of higher mortality(χ^(2)=33.2).CONCLUSION Presence of greater than 2+MR in patients with severe AS is independently associated with reduced survival in surgically managed patients,an effect incremental to reduced EF and larger LV *** suggest that aortic valve intervention should be considered in severe AS patients when>2+MR occurs irrespective of EF or symptoms.

关键词： aortic stenosis Mitral regurgitation aortic valve replacement Long term survival

Nursing of 9 cases of double-hole thoracoscopic aortic valve replacement surgery

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South China Journal of Cardiology 2023年第2期24卷 85-90页

作者：宋海娟陈晓霞谢庆刘小民卢嫦青刘健庄建 Cardiac Surgery Room Guangdong Institute of Cardiovascular DiseaseGuangdong Provincial People's HospitalGuangzhou 510080GuangdongChina

Background Objective To summarize the nursing experience of 9 cases of double-hole thoracoscopic aortic valve *** From February 2021 to February 2022,9 patientsdiagnosed with severe aortic valve disease were enrolled,including 6 males and 3 females,with an average age(50.89±5.3)years,all of whom used double-hole thoracoscopic aortic valve *** targeted surgical nursing plans,strengthen condition monitoring,surgical nursing cooperation,and take effective nursing interventions to urgently respond to intraoperative *** Among the 9 patients,7 patients underwent mechanical valve replacement and 2 patients underwent biovalve replacement,of which 2 patients underwent aortic root enlargement surgery at the same time,and none of the patients underwent intraoperative emergency transfer *** extracorporeal bypass time was(137.56±27.99)min,the aortic occlusion time was(95.33±17.96)min,and the surgical survival rate was 100%;All patients had well-placed aortic valves,and 2 had mild(aortic valve disease,double-hole thoracoscopic aortic valve replacement is a safe and effective surgical treatment with good early clinical *** a scientifically based nursing plan during surgery to effectively prevent complications,promote early recovery,and improve the quality of nursing.

关键词： Double-hole method Thoracoscopy aortic valve replacement Surgical care

Effect of aortic valve replacement on ventricular recovery and functional class in patients with reduced left ventricular function

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World Journal of Cardiovascular Diseases 2013年第9期3卷 543-550页

作者： Mahdi Ait Houssa Younes Moutakiallah Abdessamad Abdou Abdedaim Hatim Mohamed Drissi Brahim Amahzoune Youssef El Bekkali Atif Benyass Abdelatif Boulahya Cardiac Surgery Department Mohammed V Military HospitalRabatMorocco ICU of Cardiac Surgery Department Mohammed V Military HospitalRabatMorocco Cardiology Department Mohammed V Military HospitalRabatMorocco

Objective: The aim of the study was to assess the effects of aortic valve replacement (AVR) in patients with aortic stenosis (AS) or regurgitation (AR) and left ventricular (LV) dysfunction. Patients and methods: Retrospective analysis identified 75 consecutive patients with left ventricular ejection fraction (LVEF) assessed by echocardiography aortic disease. Follow-up evaluated the New York Heart Association (NYHA) functional class, LVEF and survival rate. Results: Mean ages were respectively 56.5 ± 9.3 and 47.9 ± 11.7 years in AS and AR groups, p = 0.001. Before surgery, 88% and 75% of patients were in NYHA III-IV respectively in AS and AR. In the AS group, the mean LVEF and aortic valve area (AVA) were respectively 32.2% ± 8% and 0.65 ± 0.15 cm2. AR group had a mean LVEF of 33.8 ± 6.7% and a mean LV systolic diameter of 62 ± 8.8 mm. All patients underwent AVR under cardiopulmonary bypass. There were 5 operative deaths (12.5%) in AS group and 6 (17.6%) in AR group, p = 0.57. LVEF increased to 49% ± 14.7% and 51.2% ± 10.9% in the AS and AR groups after echocardiography control. The survival rates at 1, 5 and 10 years were respectively 94.4%, 87% and 80% in AS group and 95.2%, 93% and 89% in AR group. Conclusion: Despite higher perioperative mortality in patients with aortic valve disease (AS or AR) and LV dysfunction, long-term outcome is excellent. We, therefore, conclude that AVR can be performed and it should not be denied to patients on the basis of low EF alone.

关键词： aortic valve Disease aortic valve replacement Left Ventricular Dysfunction

Aorto-Pulmonary Artery Fistula Following aortic valve replacement: A Diagnostic Dilemma

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World Journal of Cardiovascular Surgery 2016年第3期6卷 40-43页

作者： Tarun Raina Ramman Shyamveer Khangarot Sunil Kumar M. A. Geelani D. K. Satsangi Department of Cardiothoracic and Vascular Surgery GIPMER Hospital New Delhi India

Aorto-pulmonary artery fistula is a rare and lethal occurrence after thoracic surgery and aortic aneurysms. Here we present a rare occurrence of acute aorto-pulmonary artery fistula in outpatient department in a follow up patient of aortic valve replacement and discuss challenges faced in diagnosis, etiopathogenesis and management.

关键词： Aorto-Pulmonary Fistula aortic valve replacement Rare Complications