Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Binder, Ronald K.; Stortecky, Stefan; Heg, Dik; Tueller, David; Jeger, Raban; Toggweiler, Stefan; Pedrazzini, Giovanni; Amann, Franz W.; Ferrari, Enrico; Noble, Stéphane; Nietlispach, Fabiàn; Maisano, Francesco; Räber, Lorenz; Roffi, Marco; Grünenfelder, Jürg; Jüni, Peter; Huber, Christoph; Windecker, Stephan; Wenaweser, Peter

doi:10.1161/circinterventions.115.002653

Cited by 65 publications

(25 citation statements)

References 39 publications

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confidence: 99%

“…[1][2][3][4][5][6][7] Consequently, most patients undergoing TAVI are old and have multiple comorbidities. [1][2][3][4][5][6][7][8][9] In these patients, functional aspects, especially cognitive function, are highly relevant. [8][9][10][11] In a previous analysis, we showed that patients with impaired cognitive function before TAVI have an ≈3-fold increased risk of mortality at 1-year follow-up as compared with those with normal cognitive function and that cognitive impairment is also associated with increased morbidity as well as with disability and reduced quality of life after TAVI.…”

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Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

Schoenenberger

Zuber

Moser

et al. 2016

Circ: Cardiovascular Interventions

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Consecutive patients ≥70 years with symptomatic severe aortic stenosis and referred for TAVI evaluation to Bern University Hospital, Background-This study aimed to assess the evolution of cognitive function after transcatheter aortic valve implantation (TAVI). Previous smaller studies reported conflicting results on the evolution of cognitive function after TAVI. Methods and Results-In this prospective cohort, cognitive function was measured in 229 patients ≥70 years using the Mini Mental State Examination before and 6 months after TAVI. Cognitive deterioration or improvement was defined as change of ≥3 points decrease or increase in the Mini Mental State Examination score between baseline and follow-up. Cognitive deterioration was found in 29 patients (12.7%). Predictive analysis using logistic regression did not identify any statistically significant predictor of cognitive deterioration. A review of individual medical records in 8 patients with a major Mini Mental State Examination score decrease of ≥5 points revealed specific causes in 6 cases (postinterventional delirium in 2; postinterventional stroke, progressive renal failure, progressive heart failure, or combination of preexisting cerebrovascular disease and mild cognitive impairment in 1 each). Among 48 patients with impaired baseline cognition (Mini Mental State Examination score <26 points), 18 patients (37.5%) cognitively improved. The preinterventional aortic valve area was lower in patients who cognitively improved (median aortic valve area 0.60 cm 2 ) as compared with patients who did not improve (median aortic valve area 0.70 cm 2 ; P=0.01). Conclusions-This is the first study providing evidence that TAVI results in cognitive improvement among patients who had impaired preprocedural cognitive function, possibly related to hemodynamic improvement in patients with severe aortic stenosis. Our results confirm that some patients experience cognitive deterioration after TAVI. (Circ Cardiovasc Interv. 2016;9:e003590.

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Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

Schoenenberger

Zuber

Moser

et al. 2016

Circ: Cardiovascular Interventions

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“…In addition, as novel generation valves appear to have addressed the issue of PVL, other interactions – conduction abnormalities in particular – need to be predicted by the simulation program. For instance, the incidence of moderate or severe aortic regurgitation after Lotus and Edwards Sapien 3 valve implantation is 1% but are associated with a new pacemaker implantation rate of 32 and 17%, respectively [13, 14]. …”

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confidence: 99%

“…Both conditions are of clinical importance since, depending on the patient’s baseline risk, they may be associated with impaired prognosis [10–12]. Novel generation devices have to a large extent addressed the issue of PVL but are associated with a higher incidence of conduction abnormalities in comparison to preceding valve designs [13, 14]. Yet, PVL still occurs and a number of other (rare) complications can happen such as aortic root rupture, coronary obstruction or valve embolisation [15–18].…”

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confidence: 99%

Patient-specific computer modelling – its role in the planning of transcatheter aortic valve implantation

Faquir¹,

Ren²,

Mieghem³

et al. 2016

Neth Heart J

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Transcatheter aortic valve implantation is increasingly used to treat patients with severe aortic stenosis who are at increased risk for surgical aortic valve replacement and is projected to be the preferred treatment modality. As patient selection and operator experience have improved, it is hypothesised that device-host interactions will play a more dominant role in outcome. This, in combination with the increasing number of valve types and sizes, confronts the physician with the dilemma to choose the valve that best fits the individual patient. This necessitates the availability of pre-procedural computer simulation that is based upon the integration of the patient-specific anatomy, the physical and (bio)mechanical properties of the valve and recipient anatomy derived from in-vitro experiments. The objective of this paper is to present such a model and illustrate its potential clinical utility via a few case studies.

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“…These results have been observed in other contemporary studies. 19,20 However, the association between the grade of PVR and the degree of AVC across the several iterations of the same valve prosthesis has not been investigated so far. In the present study, we demonstrated that the grade of significant PVR is independently associated with the degree of AVC according to Agatston calcium scoring (log-transformed Agatston score, odds ratio 3.478, 95% CI 1.424 to 8.498, p ¼ 0.006).…”

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confidence: 99%

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

Kong

Rosendael

Kley

et al. 2016

The American Journal of Cardiology

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The iterations of the SAPIEN prosthesis might impact the incidence and grade of paravalvular regurgitation (PVR). The aim of this study was to assess the impact of iterations of balloon-expandable valves (SAPIEN, SAPIEN XT, and SAPIEN 3) and degree of aortic valve calcification (AVC) on the severity of PVR after transcatheter aortic valve implantation (TAVI). Comprehensive echocardiographic examinations and multidetector computed tomography (MDCT) were performed in 272 patients (127 men, 81 ± 7 years old, logistic EuroScore of 21 ± 13%) who underwent TAVI with 23- and 26-mm balloon-expandable valves. The degree of AVC was assessed with MDCT. PVR grade was assessed with echocardiography. The cover index was calculated as (prosthesis area - MDCT annulus area)/prosthesis area. SAPIEN, SAPIEN XT, and SAPIEN 3 prostheses were implanted in 103 patients (38%), 105 patients (38.5%), and 64 patients (23.5%), respectively. Significant PVR (≥moderate) occurred in 14%, 10%, and 0% of patients receiving the SAPIEN, SAPIEN XT, and SAPIEN 3, respectively (p = 0.010). Across the groups, the aortic annulus size, degree of calcification, and cover index were comparable. Larger burden of AVC was independently associated with significant PVR (odds ratio 3.48, p = 0.006) after adjusting for age, body surface area, gender, aortic annulus area, cover index, and prosthesis iteration. SAPIEN 3 was associated with lower frequency of significant PVR (odds ratio 0.31, p = 0.002). In conclusion, the incidence of significant PVR significantly decreased over time with improvement in valve design. SAPIEN 3 was associated with less significant PVR after TAVI independently of the AVC burden.

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Procedural Results and Clinical Outcomes of Transcatheter Aortic Valve Implantation in Switzerland

Abstract: Key Words: aortic valve stenosis ◼ bleeding ◼ transcatheter aortic valve replacement ◼ transcatheter heart valve ◼ transcutaneous aortic valve implantation ◼ vascular complications

Cited by 65 publications

References 39 publications

Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

Evolution of Cognitive Function After Transcatheter Aortic Valve Implantation

Patient-specific computer modelling – its role in the planning of transcatheter aortic valve implantation

Impact of Different Iterations of Devices and Degree of Aortic Valve Calcium on Paravalvular Regurgitation After Transcatheter Aortic Valve Implantation

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