Outcomes and Safety of Transcatheter Aortic Valve Implantation With and Without Routine Use of Transesophageal Echocardiography

Bhatnagar, Udit; Gedela, Maheedhar; Sethi, Prince; Desai, Chirag; Petraskova, Terezia; Heard, Alex; Thompson, Paul A.; Styś, Adam; Styŝ, Tomasz

doi:10.1016/j.amjcard.2018.06.037

Cited by 5 publications

(6 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,11 Bhatnagar and colleagues showed that the omission of TEE during TAVR was associated with shorter procedural time and length of hospital stay with no effect on periprocedural complications or 30-day readmission rates. 12 Studies comparing outcomes with the use of GA and MAC in TAVR were able to demonstrate shorter procedural time, fluoroscopy time, less use of vasopressor and inotropes, briefer ICU stay, and shorter hospital stay with MAC. However, there have been inconsistent results regarding mortality benefit with either approach.…”

Section: Discussionmentioning

confidence: 97%

“…6,11 Bhatnagar and colleagues showed that the omission of TEE during TAVR was associated with shorter procedural time and length of hospital stay with no effect on periprocedural complications or 30-day readmission rates. 12 Studies comparing outcomes with the use of GA and MAC in bleeding, procedural success, conduction abnormalities, annular rupture, myocardial infarction, or cardiovascular mortality. 5 The timing of myocardial infarction and cardiovascular mortality was not defined in…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience

Sammour

Kerrigan

Banerjee

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

Background: Monitored anesthesia care (MAC) has become more widely used during transcatheter aortic valve replacement (TAVR) to avoid the complications of general anesthesia (GA). Methods:We included consecutive patients who underwent transfemoral-TAVR at our institution between January 2012 and April 2017. We compared outcomes with GA versus MAC.Results: Of 998 patients, MAC was used in 43.9%. MAC was associated with shorter

show abstract

Section: Discussionmentioning

confidence: 97%

“…6,11 Bhatnagar and colleagues showed that the omission of TEE during TAVR was associated with shorter procedural time and length of hospital stay with no effect on periprocedural complications or 30-day readmission rates. 12 Studies comparing outcomes with the use of GA and MAC in bleeding, procedural success, conduction abnormalities, annular rupture, myocardial infarction, or cardiovascular mortality. 5 The timing of myocardial infarction and cardiovascular mortality was not defined in…”

Section: Discussionmentioning

confidence: 99%

Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience

Sammour

Kerrigan

Banerjee

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…In general, TEE guidance may be reserved for patients with an extremely poor TTE window. Similarly, in a single-center retrospective analysis no differences in regard to periprocedural complications and 30-day readmissions were seen between subgroups with TEE guidance (n = 104) versus without (n = 74) [25]. TEE guidance was not associated with a lower incidence of moderate and severe paravalvular leak in another observation, either [26].…”

Section: Role Of Echocardiographic and Computed Tomography Evaluationmentioning

confidence: 79%

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

Chmielak¹,

Dąbrowski²,

Tyczyński³

et al. 2020

pwki

View full text Add to dashboard Cite

Introduction: Severe aortic stenosis (AS) is an ever-growing healthcare problem in ageing populations. Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of AS. However, TAVI in patients who have undergone mitral valve replacement (MVR) is associated with increased risk of mitral valve damage. Limited data exist on TAVI in patients with AS who underwent MVR in the past. Aim: To retrospectively assess the clinical characteristics, detailed echocardiographic and computed tomography measurements, procedural and in-hospital outcome as well as any valve intervention or major adverse cardiovascular events according to VARC-2 criteria at follow-up of patients with a history of MVR, who underwent TAVI. Material and methods: Seventeen patients with a history of mitral valve operation, in whom TAVI was performed between 2010 and 2018, were identified. Of these, 15 underwent previous MVR. Results: Overall, TAVI resulted in a decrease of mean transaortic gradient by 38.3 ±14 mm Hg (p < 0.001) and a decrease of maximal transaortic gradient by 58.6 ±27.6 mm Hg (p < 0.001). A successful immediate result was obtained in 14 (93.3%) patients. One tamponade occurred during TAVI, which was successfully treated with pericardiocentesis. Post-procedurally, no significant changes in transmitral gradients or mitral regurgitations were observed. Two patients died after hospital discharge, one due to possible internal bleeding and the other due to infection. Conclusions: TAVI in patients after MVR is feasible. Meticulous preinterventional echocardiographic and computed tomography planning is essential. Although recommended in previous reports, TEE guidance may not necessarily be obligatory during the procedure.

show abstract

“…This approach reduces the invasive nature of the procedure, as well as potentially reducing the resources required and the costs 18–20. It has also been shown that periprocedural TEE can be omitted without compromising outcomes after TAVI, and that this is associated with a reduced procedural time and shorter length of stay in hospital 22 32. Percutaneous access and closure can be used safely in appropriate patients and can facilitate quicker ambulation and improved comfort for patients 21 33.…”

Section: Discussionmentioning

confidence: 99%

“…Third, periprocedural transoesophageal echocardiography (TEE) has been extensively used historically, but the focus is shifting from routine use of TEE and general anaesthesia to ‘as needed’ use. It has been shown that its omission was associated with similar rates of paravalvular leak, similar gradients and velocities across the aortic valve and comparable 30-day outcomes but with a reduced procedure length and length of stay 22 23. Finally, postprocedural length of stay has been shown to be a major determinant of patient outcomes and quality of life after surgical and interventional procedures.…”

Section: Introductionmentioning

confidence: 99%

Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo determine the effect of introducing several procedural refinements of transfemoral transcatheter aortic valve implantation (TAVI) on clinical outcomes and costs.DesignRetrospective analysis comparing two consecutive 1-year periods, before and after the introduction of procedural refinements.SettingTertiary hospital aortic valve programme.ParticipantsConsecutive patients undergoing transfemoral TAVI treated between April 2014 and August 2015 using the initial setup (n=70; control group) or between September 2015 and August 2016 after the introduction of procedural refinements (n=89).InterventionsIntroduction of conscious sedation, percutaneous access and closure, omission of transoesophageal echocardiography during the procedure, and an early discharge procedure.Outcome measuresProcedural characteristics, complications and outcomes; length of stay in intensive care unit (ICU) and hospital; hospital-related direct costs associated with TAVI.ResultsThere were no statistically significant differences in the incidence of complications or mortality between the two groups. The mean length of stay in the ICU was significantly shorter in the procedural-refinement group compared with the control group (5.1 vs 57.2 hours, p<0.001), as was the mean length of hospital stay (4.7 vs 6.6 days, p<0.001). The total cost per TAVI procedure was significantly lower, by £3580, in the procedural-refinement group (p<0.001). This was largely driven by lower ICU costs.ConclusionsAmong patients undergoing transfemoral TAVI, procedural refinement facilitated a shorter stay in ICU and earlier discharge from hospital and was cost saving compared with the previous setup.

show abstract

Outcomes and Safety of Transcatheter Aortic Valve Implantation With and Without Routine Use of Transesophageal Echocardiography

Cited by 5 publications

References 23 publications

Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience

Comparing outcomes of general anesthesia and monitored anesthesia care during transcatheter aortic valve replacement: The Cleveland Clinic Foundation experience

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

Effect of procedural refinement of transfemoral transcatheter aortic valve implantation on outcomes and costs: a single-centre retrospective study

Contact Info

Product

Resources

About