Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis.

Otto, Catherine M.; Mickel, Mary; Kennedy, J. Ward; Alderman, Edwin L.; Bashore, Thomas M.; Block, Peter C.; Brinker, Jeffrey A.; Diver, D; Ferguson, James F.; Holmes, David R.

doi:10.1161/01.cir.89.2.642

Cited by 401 publications

(243 citation statements)

References 36 publications

Supporting

Mentioning

195

Contrasting

Unclassified

Order By: Relevance

“…Our operative mortality for AVR after failed valvuloplasty was 75% (6/8 patients), which was much higher than in the series of Otto et al [9], who reported an operative mortality of 12% after failed aortic valvuloplasty. However, it is possible that, in our series, those patients referred for valvuloplasty were initially felt to be very poor surgical candidates.…”

Section: Operative Mortality and Morbiditycontrasting

confidence: 61%

See 1 more Smart Citation

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

118

View full text Add to dashboard Cite

long-term results Aortic valve surgery in octogenarians: predictive factors for operative and This information is current as of April 2, 2007http://ejcts.ctsnetjournals.org/cgi/content/full/31/4/600 located on the World Wide Web at:The online version of this article, along with updated information and services, is AbstractObjective: To assess factors influencing operative and long-term outcome in octogenarians undergoing aortic valve surgery (AVR). Methods: Records of 220 consecutive octogenarians having AVR between 1992 and 2004 were reviewed, and follow-up obtained (99% complete). Of the group (mean age: 82.8 years; 174 females), 142 patients (65%) were in New York Heart Association (NYHA) class III-IV, 22 (10%) had previous myocardial infarction, 11 (5%) had previous coronary artery bypass grafting (CABG), and 8 (4%) had percutaneous aortic valvuloplasty. There were 44 urgent procedures (20%), and additional CABG was performed in 58 patients (26%). Results: Operative mortality was 13% (9% for AVR, 24% for AVR + CABG). Among the 29 patients who died, 14 (48%) were operated on urgently (32% mortality for urgent procedures). Causes of hospital death were respiratory insufficiency or infection in 16 patients (16/29 = 55%), myocardial infarction in 8 (28%), stroke in 2 (7%), sepsis in 2 (7%), and renal failure in 1 (3%). Significant postoperative complications were atrial fibrillation in 48 patients (22%), respiratory insufficiency in 46 (21%), permanent atrio-ventricular bloc in 12 (5%), myocardial infarction in 10 (5%), hemodialysis in 4 (2%), and stroke in 4 (2%). Mean hospital and intensive care unit (ICU) stays were 17.6 AE 5.2 and 6.9 AE 3.4 days, respectively. Multivariate predictors ( p < 0.05) of hospital death were urgent procedure, associated CABG, NYHA class IV, and percutaneous aortic valvuloplasty. Age, associated CABG, and urgent procedure were predictors of prolonged ICU stay. Mean follow-up was 58.2 months and actuarial 5-year survival was 73.2 AE 6.9%. Age, preoperative myocardial infarction, urgent procedure, and duration of ICU stay were independent predictors of late death. Among 130 patients alive at follow-up, 91% were angina free and 81% in class I-II. Conclusions: AVR in octogenarians can be performed with acceptable mortality, although significant morbidity. These results stress the importance of early operation on elderly patients with aortic valve disease, avoiding urgent procedures. Associated coronary artery disease is a harbinger of poor operative outcome. Long-term survival and functional recovery are excellent. #

show abstract

Section: Operative Mortality and Morbiditycontrasting

confidence: 61%

“…Nevertheless, published hospital mortality ranged from 3 to 10% [8,9], and hospital morbidity from 10 to 25%. Furthermore, the majority of patients had restenosis within 6 months and survival curves showed 55-75% survival at 1 year [8,9].…”

Section: Discussionmentioning

confidence: 99%

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Kolh¹,

Kerzmann

Honoré³

et al. 2007

European Journal of Cardio-Thoracic Surgery

184

118

View full text Add to dashboard Cite

show abstract

“…3,4 Esses achados estimularam o desenvolvimento de dispositivos para a substituição da valva aórtica por cateter. Em 2002, Cribier et al 5 realizaram, com sucesso, o primeiro implante percutâneo de uma biopró-tese valvular aórtica em seres humanos, dando início a uma nova era na cardiologia intervencionista.…”

Section: Key-wordsunclassified

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Júnior¹,

Siqueira²,

Sarmento‐Leite³

et al. 2011

Rev. Bras. Cardiol. Invasiva

View full text Add to dashboard Cite

RESUMOIntrodução: A substituição cirúrgica da valva aórtica é o tratamento de eleição para pacientes com estenose aórtica acentuada. Entretanto, o risco cirúrgico aumenta expressivamente com o avançar da idade e com a associação de comorbidades. Recentemente, iniciou-se a experiência com o implante por cateter de biopróteses aórticas no Brasil. Justifica-se, portanto, a criação de um registro nacional para conhecimento dos resultados desse tipo de procedimento em nosso meio. Descrevemos o racional e o desenho do Registro Brasileiro de Implante de Bioprótese Aórtica por Cateter. Métodos: Trata-se de um registro multicêntrico, prospectivo, que incluirá 200 pacientes portadores de estenose valvar aórtica sintomática de alto risco cirúrgico submetidos a implante por cateter de bioprótese valvular aórtica em centros brasileiros. O desfecho primário do estudo é a mortalidade por qualquer causa aos 30 dias, 12 meses e 24 meses. Os desfechos secundários avaliados incluem, entre outros: 1) sucesso técnico do implante da bioprótese; 2) mortalidade cardiovascular aos 30 dias, 12 meses e 24 meses; 3) desfecho combinado de segurança aos 30 dias; e 4) desfecho combinado de eficácia aos 12 meses e 24 meses. Conclusões: A análise dos resultados desse registro ABSTRACT Rationale and Design of the Brazilian TranscatheterAortic Valve Implantation Registry

show abstract

“…Whereas balloon valvuloplasty represents an alternative therapeutic option, the reduction in stenosis is modest and temporary. 5,6 Percutaneous approaches to AV replacement have been investigated since 1992. 7 in 2002, Cribier et al 8 reported a successful percutaneous valve replacement via an antegrade transseptal approach through the femoral vein.…”

Section: éLéments Cliniques : Une Fois Le Consentement Du Comité D'étmentioning

confidence: 99%

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Ree

Bowering

Schwarz

2008

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose: To describe both the evolution and the main associated complications in the anesthetic management of the initial 40 patients at our centre who underwent percutaneous retrograde aortic valve replacement, a novel technique utilizing a catheterguided femoral artery approach. Clinical features:With institutional Research Ethics Board approval, we retrospectively reviewed the medical records of the first 40 patients who underwent percutaneous retrograde aortic valve replacement between January 2005 and March 2006. Information obtained included patient characteristics, anesthetic management, details of the procedure, and complications. All procedures were scheduled to be performed in the cardiac catheterization laboratory. The first four patients received monitored anesthesia care, and the subsequent 36 underwent general anesthesia. There were no anesthesia-related adverse events. The prosthetic valve was placed successfully in 33/40 patients (83%). Median anesthetic time was 3.5 hr (range, 1.25-7.25 hr). Thirty-two/40 patients required vasopressor support. The most common, serious procedural complications were myocardial ischemia and arrhythmia following rapid ventricular pacing, hemorrhage from vascular injury secondary to the placement and removal of the large-bore sheath in the ilio-femoral artery, aortic rupture, and prosthetic valve maldeployment; 30-day mortality was 13% (n = 5/40). Conclusions:Percutaneous retrograde aortic valve replacement is a novel procedure that presents the anesthesiologist with unique challenges. Careful preoperative assessment, intraoperative monitoring appropriate for a major vascular procedure, and meticulous management of hemodynamics are imperative for a successful outcome. Serious complications, including major hemorrhage from vascular injury as well as arrhythmia and myocardial ischemia following rapid ventricular pacing, must be anticipated and managed in an expeditious fashion.

show abstract

Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis.

Abstract: Background To identify predictors of long-term outcome after balloon aortic valvuloplasty, we analyzed data on 674 adults (mean age, 78±9 years; 56% were women) undergoing

Cited by 401 publications

References 36 publications

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Aortic valve surgery in octogenarians: predictive factors for operative and long-term results

Racional e desenho do registro brasileiro de implante de bioprótese aórtica por cateter

Case series: anesthesia for retrograde percutaneous aortic valve replacement — experience with the first 40 patients

Contact Info

Product

Resources

About