Patients with aortic stenosis referred for TAVI: treatment decision, in-hospital outcome and determinants of survival

Nuis, Rutger-Jan; Dager, Antonio; Boon, Robert M. van der; Jaimes, Marisol Carreño; Caicedo, Bernardo; Fonseca, J; Mieghem, Nicolás M. Van; Benítez, Luis; Umaña, Juan P.; O’Neill, William W.; Marchena, Eduardo de; Jaegere, Peter P. de

doi:10.1007/s12471-011-0224-z

Cited by 29 publications

(27 citation statements)

References 24 publications

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“…In the present study, advanced CKD was associated with worse outcomes (mortality, bleeding, and stroke) in high‐risk TAVR patients. This is in line with previous studies demonstrating that advanced CKD is an independent risk factor for mortality, stroke, and bleeding events in TAVR patients . The findings herein corroborate these earlier reports and the observation that mortality, bleeding events, and stroke cluster in this cohort.…”

Section: Discussionsupporting

confidence: 93%

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Makki

Lilly

2018

Clinical Cardiology

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Chronic kidney disease (CKD) is associated with worse outcomes in high-surgical-risk patients undergoing transcatheter aortic valve replacement (TAVR). However, it is unclear whether this relationship is apparent in lower-surgical-risk patients. We sought to analyze existing literature to assess whether or not advanced CKD is associated with increased mortality or a greater incidence of adverse events (specifically major stroke, bleeding, and vascular complications). We searched PubMed and Embase (2008-2017) for relevant studies. Studies with <1 year follow-up and those not evaluating advanced CKD or outcomes post-TAVR were excluded. Our co-primary endpoints were the incidence of short-term mortality (defined as in-hospital or 30-day mortality) and long-term mortality (1 year). Our secondary endpoints included incidence of major stroke, life-threatening bleeding, and major vascular complications. Eleven observational studies with a total population of 10709 patients met the selection criteria. Among patients with CKD there was an increased risk of short- and long-term mortality in high-surgical-risk patients who underwent TAVR (hazard ratio [HR]: 1.51, 95% confidence interval [CI]: 1.22-1.88 and HR: 1.56, 95% CI: 1.38-1.77, respectively; P < 0.01). However, there was no association between CKD and mortality in low- to intermediate-risk patients (HR: 1.35, 95% CI: 0.98-1.84, P = 0.06 in short-term and HR: 1.08, 95% CI: 0.92-1.27, P = 0.34 in long-term). In low- to intermediate-risk TAVR patients, advanced CKD is not associated with increased mortality or poorer safety outcomes. These findings should be factored into the clinical decision-making process regarding TAVR candidacy.

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Section: Discussionsupporting

confidence: 93%

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Makki

Lilly

2018

Clinical Cardiology

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“…Patients who are referred for TAVI are older and, therefore, more often have associated cardiac and noncardiac chronic disease or comorbid conditions, which both may explain a higher prevalence of anemia in these patients. 4,28,29 In accordance with 4 previous studies that reported the cause or determinants of anemia in patients with heart disease, we found kidney impairment and peripheral vascular disease to be related to preoperative anemia. 7,12,15,30 These and almost all other factors associated with anemia in the present analysis are common in patients with anemia and frequently seen in patients who currently undergo TAVI.…”

Section: Prevalence and Factors Associated With Anemiasupporting

confidence: 91%

“…16 All procedures were performed under local or general anesthesia using the Medtronic CoreValve System (valve sizes 23,26,29, and 31 mm), the Edwards SAPIEN or SAPIEN XT Valve (valve sizes 23,26, and 29 mm), or the Direct Flow Valve (valve sizes 24 and 25 mm). After TAVI, antiplatelet therapy consisted of clopidogrel 75 mg for 6 months and aspirin 80 to 100 mg indefinitely.…”

Section: Methodsmentioning

confidence: 99%

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Nuis¹,

Sinning

Rodés‐Cabau

et al. 2013

Circ: Cardiovascular Interventions

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Background-There is scant information on the prevalence and factors associated with preoperative anemia in patients undergoing transcatheter aortic valve implantation (TAVI) and whether it is associated with mortality. We sought to determine the prevalence and factors associated with preoperative anemia in addition to the prognostic effects of the various levels of preoperative hemoglobin level on mortality in patients undergoing TAVI. Methods and Results-Ten-center observational study encompassing 1696 patients with aortic stenosis who underwent TAVI was conducted. Anemia was defined by the World Health Organization criteria (hemoglobin <12.0 g/dL in women and <13.0 g/dL in men). but showed the strongest association with 1-year mortality with a hazard ratio (95% confidence interval) of 2.78 (1.60-4.82) in patients with hemoglobin <10 g/dL. Patients with anemia received ≥1 blood transfusion 2× more often, but the indication of transfusion was unrelated to overt bleeding in 60%. Blood transfusion was associated with mortality at 30 days (odds ratio, 1.25 [95% confidence interval, 1.08-3.67]) and during follow-up (hazard ratio, 1.09 [95% confidence interval, 1.03-1.14]). Conclusions-Preoperative anemia is prevalent in >50% of patients undergoing TAVI. Various baseline factors were related to anemia, which in turn was associated with 1-year mortality. Patients with anemia received more transfusions but mostly for indications unrelated to overt bleeding, whereas transfusion was independently associated with both early and 1-year mortality. These findings indicate that optimization of baseline factors related to preoperative anemia, in addition to more strict criteria of the use of blood products, may improve outcome after TAVI. (Circ Cardiovasc Interv. 2013;6:625-634.)

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“…According to our results, both logistic EuroSCORE and EuroSCORE II could be used as scoring systems for prediction of annual mortality or incidence of standardized combined endpoints following TAVI but with limited sensitivity and specificity. So far, papers using standardized endpoints defined according to VARC [11] that will enable a comparison of individual studies in the future have been published only sporadically [21].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Utility of Biomarkers in Predicting of One-Year Outcomes in Patients with Aortic Stenosis Treated with Transcatheter or Surgical Aortic Valve Implantation

et al. 2012

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ObjectivesThe aim of the work was to find biomarkers identifying patients at high risk of adverse clinical outcomes after TAVI and SAVR in addition to currently used predictive model (EuroSCORE).BackgroundThere is limited data about the role of biomarkers in predicting prognosis, especially when TAVI is available.MethodsThe multi-biomarker sub-study included 42 consecutive high-risk patients (average age 82.0 years; logistic EuroSCORE 21.0%) allocated to TAVI transfemoral and transapical using the Edwards-Sapien valve (n = 29), or SAVR with the Edwards Perimount bioprosthesis (n = 13). Standardized endpoints were prospectively followed during the 12-month follow-up.ResultsThe clinical outcomes after both TAVI and SAVR were comparable. Malondialdehyde served as the best predictor of a combined endpoint at 1 year with AUC (ROC analysis) = 0.872 for TAVI group, resp. 0.765 (p<0.05) for both TAVI and SAVR groups. Increased levels of MDA, matrix metalloproteinase 2, tissue inhibitor of metalloproteinase (TIMP1), ferritin-reducing ability of plasma, homocysteine, cysteine and 8-hydroxy-2-deoxyguanosine were all predictors of the occurrence of combined safety endpoints at 30 days (AUC 0.750–0.948; p<0.05 for all). The addition of MDA to a currently used clinical model (EuroSCORE) significantly improved prediction of a combined safety endpoint at 30 days and a combined endpoint (0–365 days) by the net reclassification improvement (NRI) and the integrated discrimination improvement (IDI) (p<0.05).Cystatin C, glutathione, cysteinylglycine, asymmetric dimethylarginine, nitrite/nitrate and MMP9 did not prove to be significant. Total of 14.3% died during 1-year follow-up.ConclusionWe identified malondialdehyde, a marker of oxidative stress, as the most promising predictor of adverse outcomes during the 30-day and 1-year follow-up in high-risk patients with symptomatic, severe aortic stenosis treated with TAVI. The development of a clinical “TAVIscore” would be highly appreciated. Such dedicated scoring system would enable further testing of adjunctive value of various biomarkers.

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Patients with aortic stenosis referred for TAVI: treatment decision, in-hospital outcome and determinants of survival

Cited by 29 publications

References 24 publications

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Advanced chronic kidney disease: Relationship to outcomes post‐TAVR, a meta‐analysis

Prevalence, Factors Associated With, and Prognostic Effects of Preoperative Anemia on Short- and Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

Prognostic Utility of Biomarkers in Predicting of One-Year Outcomes in Patients with Aortic Stenosis Treated with Transcatheter or Surgical Aortic Valve Implantation

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