Outcomes of Transcatheter Aortic Valve Implantation in Patients with Cirrhosis

Higuchi, Ryosuke; Tobaru, Tetsuya; Hagiya, Kenichi; Mahara, Keitaro; Takamisawa, Itaru; Shimizu, Jun; Iguchi, Nobuo; Takanashi, Shuichiro; Takayama, Morimasa; Isobe, Mitsuaki

doi:10.1536/ihj.18-339

Cited by 5 publications

(10 citation statements)

References 24 publications

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“…As seen in prior studies, patients with ESLD and ESRD had longer preprocedural and postprocedural length of stay due to careful management of comorbidities preprocedure and postprocedure. 14,21 Despite longer lengths of stay, patients with ESLD and ESRD did not have higher rates of cerebrovascular events, pacemaker placement, or vascular complications. The relatively younger age of the ESLD and ESRD cohort may mean lower burden of calcific disease and, therefore, low rates of conduction abnormalities, atherosclerotic emboli, and vascular events.…”

Section: Echocardiographic Findingsmentioning

confidence: 98%

“…In patients with ESLD and ESRD, TAVR has emerged as a potential alternative to surgery, 1,6-8,13,19-21 however, there remains few studies evaluating clinical and echocardiographic outcomes after TAVR in patients pretransplant with ESLD and ESRD. [12][13][14] Though TAVR is an appealing alternative for high risk surgical patients, [19][20][21][22] cirrhosis who underwent TAVR demonstrated in-hospital mortality rates between 9 and 36%, and 1 year mortality rates between 36 and 67%. 10,11 Comparatively, this study had no in hospital deaths for the 15 patients with cirrhosis and only a 7.1% mortality rate at 1-year.…”

Section: Echocardiographic Findingsmentioning

confidence: 99%

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Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Caughron

Parikh

Allison

et al. 2021

Cathet Cardio Intervent

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Objectives This study evaluates in‐hospital, 30‐day, and 1‐year outcomes post‐transcatheter aortic valve replacement (TAVR) in end stage liver disease (ESLD) and/or end stage renal disease (ESRD) compared with patients without these comorbidities. Background TAVR is an alternative to surgical aortic valve replacement in patients with ESLD and ESRD, though current outcomes data are limited. Methods We compared 309 patients (N = 29 ESLD and/or ESRD, N = 280 control) age > 18 who underwent transfemoral TAVR from 2014 to 2020 have been compared. Results Patients with ESLD and ESRD were younger (69.9 ± 11.7 vs. 79.1 ± 9.8, p < .01) with higher STS‐PROM scores (8.1 ± 6.7 vs. 4.6 ± 3.9, p < .01). ESRD and ESLD patients had similar rates of in‐hospital major vascular complications (3.4% vs. 3.2%, p = .96), major bleeding events (3.4% vs. 3.2%, p = .95), and mortality (0.0% vs. 1.8%, p = .47). Mortality rates were similar at 30‐days (3.4% vs. 2.1%, p = .65) with trend to higher mortality at 6‐months (6.9% vs. 3.2%, p = .31) and 1‐year (15.4% vs. 7.0%, p = .13). Readmission rates were higher in the ESLD and ESRD cohort at 6‐months (53.2% vs. 28.6%, p < .01) and 1‐year (65.4% vs. 41.0%, p = .02). One patient received dual kidney–liver transplant, 1 patient received a liver transplant, and 7 additional patients were listed for transplant. Conclusion Patients with ESLD and/or ESRD who underwent TAVR had similar mortality at discharge and 30‐days compared with patients without these comorbidities with a trend toward increased mortality at 1‐year. This study suggests that TAVR is an option for aortic valve disease patients with ESRD and/or ESLD in order to remove cardiac barriers to liver or kidney transplant.

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Section: Echocardiographic Findingsmentioning

confidence: 98%

Section: Echocardiographic Findingsmentioning

confidence: 99%

Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Caughron

Parikh

Allison

et al. 2021

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…1) With the increasing experience in the use of TAVI procedure and innovative devices, the incidence of complications has seen a steady decline. [2][3][4] Nevertheless, post-TAVI permanent pacemaker (PPM) implantation according to complete atrioventricular block (CAVB) remains a major complication. 5,6) The PPM implantation rate has been reported to vary from 2 to 51% according to various studies.…”

mentioning

confidence: 99%

Time Course and Risk Factors of New-Onset Complete Atrioventricular Block After Transcatheter Aortic Valve Implantation

Cha

et al. 2021

Int. Heart J.

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In this study, we aimed to investigate the time course of new-onset complete atrioventricular block (CAVB) and its reversibility after transcatheter aortic valve implantation (TAVI). We analyzed 206 consecutive patients without baseline CAVB who underwent successful TAVI. The incidence of new-onset CAVB was determined to be 12.6% (26/206). Among these patients, 14 recovered from CAVB within 2 weeks (6.8%, 14/206), while the remaining 12 (5.8%, 12/206) underwent permanent pacemaker (PPM) insertion. Among the 12 patients who received the PPM, 4 were able to recover from CAVB within 4 months. Thus, only 8 among 206 patients (3.8%) showed persistent CAVB. Early-onset CAVB on the day of the procedure was the strongest predictor of PPM implantation (OR = 127). The electrocardiographic changes that occurred after TAVI were mostly recovered after 1 month. The most critical procedural factor that predicts CAVB and PPM insertion is the deep implantation (>4 mm) of a big valve (oversizing index >5.9%). In conclusion, the incidence of CAVB after TAVI was estimated to be at 12.6%. Two-thirds of these patients recovered from CAVB within 3 days, resulting in a final rate of persistent CAVB of 4%. To prevent CAVB, we have to implant an appropriate valve type with an optimal size and depth.

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“…he effectiveness of transcatheter aortic valve implantation (TAVI) for high-risk patients with severe symptomatic aortic stenosis has been clearly established. [1][2][3] The mortality rate and other outcomes associated with TAVI have been shown to be non-inferior to those associated with surgical aortic valve replacement. 4) Recently, several reports have shown that using local anesthesia with conscious sedation (LACS) during TAVI procedures decreases the procedure duration, length of stay in intensive care units (ICUs), and need for intraprocedural anesthesia-related medication support.…”

mentioning

confidence: 99%

Perioperative Outcomes of Adjunctive Hypnotherapy Compared with Conscious Sedation Alone for Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

et al. 2020

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Transcatheter aortic valve implantation (TAVI) using a transfemoral approach under local anesthesia with conscious sedation (LACS) is becoming an increasingly common TAVI strategy. However, patients who are awake during the TAVI procedure can experience stress, anxiety, and pain, even when LACS is used. Clinical hypnotherapy is an anxiolytic intervention that can be beneficial for patients undergoing invasive surgery. This study aimed to assess the perioperative outcomes of adjunctive hypnotherapy undergoing transfemoral TAVI with LACS. Consecutive patients (n = 143) with symptomatic severe aortic stenosis who underwent transfemoral TAVI with LACS only (n = 107) or with LACS and hypnotherapy (n = 36) between January 2015 and April 2016 were retrospectively included in the study. The clinical outcomes were compared between the two groups. The LACS with hypnotherapy group had a significantly shorter length of stay in the intensive care unit (ICU; LACS only versus LACS with hypnotherapy: 4.0 (4.0-5.5) days versus 3.0 (3.0-5.0) days, P < 0.01). Moreover, the use of anesthetics (propofol and remifentanil) and norepinephrine was significantly lower in the LACS with hypnotherapy group (e.g., for propofol, LACS only versus LACS with hypnotherapy: 96.4 ± 104.7 mg versus 15.0 ± 31.8 mg, P < 0.001). The multiple regression analysis showed that being male, hypnotherapy, and the composite complication score were independently associated with the length of stay in the ICU. The adjunctive hypnotherapy on LACS among transfemoral TAVI patients may facilitate perioperative management. However, a prospective randomized study is necessary to confirm the efficacy of hypnotherapy among TAVI patients.

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Outcomes of Transcatheter Aortic Valve Implantation in Patients with Cirrhosis

Cited by 5 publications

References 24 publications

Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Outcomes of transcatheter aortic valve replacement in end stage liver and renal disease

Time Course and Risk Factors of New-Onset Complete Atrioventricular Block After Transcatheter Aortic Valve Implantation

Perioperative Outcomes of Adjunctive Hypnotherapy Compared with Conscious Sedation Alone for Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

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