Aortic Stenosis

Rajan, Rajesh; Balool, Joud Al; Jarallah, Mohammed Al; Dashti, Raja; Mulla, Khalid Al; Haroun, Retaj Al; Kobalava, ZhannaDavidovna

doi:10.4103/accj.accj_19_21

Cited by 6 publications

(1 citation statement)

References 58 publications

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“…Transcatheter aortic valve replacement (TAVR) is currently a prominent treatment option of aortic stenosis, with current volumes exceeding surgical aortic valve replacement 1 , 2 . Such therapeutic advancement led to expansion of its indication from low- to high- risk patients 3 .…”

Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

Al Jarallah,

Abdulsalam,

Rajan

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Chronic kidney disease (CKD) is a common comorbid condition in patients undergoing TAVR. Reported outcome studies on the association of baseline CKD and mortality is currently limited. Objectives: To determine the prevalence of chronic kidney disease in patients undergoing TAVR and analyse their overall procedural outcomes Methods: This retrospective observational study was conducted at 43 publicly funded hospitals in Hong Kong. Severe aortic stenosis patients undergoing TAVR between the years 2010 and 2019 were enrolled in the study. Two groups were identified according to the presence of baseline chronic kidney disease Results: A total of 499 patients (228, 58.6% men) were enrolled in the study. Baseline hypertension was more prevalent in patients with CKD (82.8%; P=0.003). As for primary endpoints, mortality rates of CKD patients were significantly higher compared to non-CKD patients (10% vs. 4.1%; P=0.04%). Gout and hypertension were found to be significantly associated with CRF. Patients with gout were nearly six times more likely to have CRF than those without gout (OR = 5.96, 95% CI = 3.12-11.29, P<0.001). Patients with hypertension had three times the likelihood of having CRF compared to those without hypertension (OR=2.83, 95% CI=1.45-6.08, P=0.004). Conclusion: In patients with severe undergoing TAVR, baseline CKD significantly contributes to mortality outcomes at long-term follow up

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Section: Introductionmentioning

confidence: 99%

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

Al Jarallah,

Abdulsalam,

Rajan

et al. 2023

Annals of Medicine &Amp; Surgery

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Development of an Electronic Frailty Index for Predicting Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement using Machine Learning

Zhang¹,

Tse²,

Chen³

et al. 2023

Annals of Clinical Cardiology

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Background: Electronic frailty indices can be useful surrogate measures of frailty. Objective: This study is to develop an electronic frailty index that incorporates patient demographics, baseline comorbidities, health-care utilization characteristics, electrocardiographic measurements, and laboratory examinations for predicting all-cause mortality in patients undergoing transcatheter aortic valve replacement (TAVR). Methods: This was a multicenter retrospective observational study of patients undergoing for TAVR. Significant univariate and multivariate predictors of all-cause mortality were identified using Cox regression. Importance ranking of variables was obtained with a gradient boosting survival tree (GBST) model, a supervised sequential ensemble learning algorithm, and used to build the frailty models. Comparisons were made between multivariate Cox, GBST, and random survival forest models. Results: A total of 450 patients (49% of females; median age at procedure, 82.3 [interquartile range, 79.0–86.0]) were included, of which 22 died during follow-up. A machine learning survival analysis model found that the most important predictors of mortality were activated partial thromboplastin time, followed by INR, severity of tricuspid regurgitation, cumulative hospital stays, cumulative number of readmissions, creatinine, urate, alkaline phosphatase, and QTc/QT intervals. GBST significantly outperformed random survival forests and multivariate Cox regression (precision: 0.91, recall: 0.89, AUC: 0.93, C-index: 0.96, and KS-index: 0.50) for mortality prediction. Conclusions: An electronic frailty index incorporating multidomain data can efficiently predict all-cause mortality in patients undergoing TAVR. A machine learning survival learning model significantly improves the risk prediction performance of the frailty models.

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Clinical Outcomes after Transcatheter Aortic Valve Replacement Stratified by Hemoglobin Levels

Rajan¹,

Haroun²,

Jarallah³

et al. 2022

Annals of Clinical Cardiology

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Background: Anemia is a prevalent comorbidity in patients undergoing aortic valve replacement. Objectives: The objectives of this study were to define baseline parameters of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) to determine procedural risk and mortality outcomes stratified by hemoglobin (Hb) levels. Methods: Retrospective study of a population of patients with severe AS undergoing TAVR with the Edwards SAPIEN 3 valve between 2018 and 2021 at Sabah Al-Ahmad Cardiac Centre, Al Amiri Hospital, Kuwait. Two cohorts were identified based on Hb level: Hb <13 and Hb ≥13 g/dl. Results: A total of 61 patients were included. The mean age was 73.5 ± 9.0 years, with a higher prevalence of females. The cohort with lower Hb had lower body surface area (2.0 ± 0.1 vs. 1.8 ± 0.2, P = 0.035) and bioprosthesis size (26.5 ± 1.8 vs. 24.4 ± 1.8, P = 0.001). Based on echocardiography, patients with higher Hb levels had a higher prevalence of aortic regurgitation in addition to stenosis (P = 0.029). Conclusions: Baseline anemia is a common comorbidity in patients with severe AS undergoing TAVR. However, in terms of procedural outcomes and mortality, Hb levels were not a predictor of post-TAVR complications or in-hospital death.

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Aortic Stenosis

Cited by 6 publications

References 58 publications

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study

Development of an Electronic Frailty Index for Predicting Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement using Machine Learning

Clinical Outcomes after Transcatheter Aortic Valve Replacement Stratified by Hemoglobin Levels

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