Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis - A New Paradigm for Multidisciplinary Intervention.

Dworakowski, Rafał; MacCarthy, Philip; Monaghan, Mark; Redwood, Simon; El‐Gamel, Adam; Young, Christopher; Bapat, Vinayat; Hancock, Jane; Wilson, Karen M.; Brickham, Beth; Rajagopal, Kailasam; Alcock, Emma; Wendler, Olaf; Thomas, Martyn

doi:10.1016/s0735-1097(10)61375-7

Cited by 20 publications

(31 citation statements)

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“…established standard of care for evaluation and treatment of patients who need transcatheter valvular intervention. [7][8][9][16][17][18] Despite the preponderance of evidence of improved clinical outcomes in other medical and surgical specialties, [1][2][3][4][5][6][7][8][9]15 an MHT approach to CAD has not been well accepted or well established. The reasons may be partly owing to logistic and/or financial incentives but may also be related to the lack of clinical data on how a real-world coronary revascularization heart team influences management decisions.…”

Section: Resultsmentioning

confidence: 99%

“…1,2 Within cardiovascular medicine, it is an established entity in the management of heart failure 3,4 and congenital heart disease 5,6 in the pediatric and adult populations and is becoming the standard of care in randomized clinical trials involving complex cardiac conditions. [7][8][9] Within the subspecialty of coronary revascularization, during the conduct of randomized clinical trials, a dedicated multidisciplinary heart team (MHT) has been used successfully. 10,11 Despite the successful implementation in randomized clinical trials and the recommendation of the latest practice guidelines that the MHT approach be incorporated into clinical practice, the current literature suggests that decision making regarding treatment modalities in patients with coronary artery disease (CAD) is often not based on empirical evidence and is subject to operator bias.…”

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confidence: 99%

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Safety and Efficacy of Implementing a Multidisciplinary Heart Team Approach for Revascularization in Patients With Complex Coronary Artery Disease

et al. 2014

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Safety and Efficacy of Implementing a Multidisciplinary Heart Team Approach for Revascularization in Patients With Complex Coronary Artery Disease

et al. 2014

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“…Single centers have published encouraging early results involving this technique with 30-day mortalities lower than predicted for AVR [2,3,6,4]. Analyses of COHORT 1 (C-1) from the SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) Registry based on 575 consecutive patients, who underwent TA-AVI, identified risk factors for 30-day mortality, which were published previously in this journal [7].…”

Section: Introductionmentioning

confidence: 92%

The SOURCE Registry: what is the learning curve in trans-apical aortic valve implantation?

Wendler

Walther

Schroefel

et al. 2011

European Journal of Cardio-Thoracic Surgery

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“…1,2) Nevertheless, this procedure carries a substantial risk of numerous cardiovascular complications, among which the bleeding events are reported as the most frequent. [3][4][5][6][7] Still, the body of evidence regarding the frequency of bleeding complications is relatively small, with significant differences in incidence between the studies, which is probably the result of differences in the applied methodology. [8][9][10] The clinical and procedural predictors of bleeding complications are not yet fully identified, and neither is their prognostic value.…”

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Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

et al. 2016

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SummaryThere are differences in reporting bleeding complications after transcatheter aortic valve implantation (TAVI), which is a consequence of the lack of consensus for their definition. Furthermore, the amount of data on the impact of peri-procedural bleeding on the mid-term prognosis is still limited. The aim of this study was to investigate the incidence, predictors, and impact of life-threatening and major bleedings as defined by the Valve Academic Research Consortium 2 (VARC-2) in patients after TAVI over the mid-term prognosis.Consecutive patients who underwent TAVI from March 2010 to December 2013 were included. All data were classified according to the VARC-2 criteria. We assessed the incidence and the predictors of serious bleeding events (SBE), defined as life-threatening/disabling (LT/D) or major bleeding, and analyzed their impact on 30-day and 1-year clinical outcome.A total of 129 patients were included (79.1 ± 8.3 years; mean EuroSCORE = 17.8 ± 12.7). The SBE occurred in 25 patients (19.4%), of which 9 (7.0%) had LT/D and 16 (12.4%) had major bleeding. Trans-subclavian (TS) access (OR 4.38, 95% CI 2.13-14.29, P = 0.01) and diabetes (OR 2.93, 95% CI 1.08-7.93, P = 0.03) were identified as independent predictors of SBE. Patients with SBE had higher 30-day mortality (20.0% versus 4.0%, P = 0.02) and 1-year mortality (40.0% versus 11.1%, P < 0.002). SBE independently predicted 1-year, all-cause mortality (HR 5.88, 95% CI 1.73-19.94, P = 0.005).SBE are frequent after TAVI and are associated with decreased short and mid-term survival. Diabetes and TS access are independent risk factors for SBE. (Int Heart J 2016; 57: 35-40) Key words: Long term prognosis, TAVR, Complications O ver the last several years we have been witnessing a substantial technical improvement and dynamic expansion of transcatheter aortic valve implantation (TAVI). Increasing operator experience and encouraging clinical outcomes data, revealing favorable results for TAVI in selected populations, have led to major changes in the management of patients with severe aortic stenosis (AS). In recent guidelines, TAVI has been recognized as an alternative method to surgical aortic valve replacement (SAVR) in high-risk patients and superior over conservative therapy in those disqualified from surgery. 1,2) Nevertheless, this procedure carries a substantial risk of numerous cardiovascular complications, among which the bleeding events are reported as the most frequent.3-7) Still, the body of evidence regarding the frequency of bleeding complications is relatively small, with significant differences in incidence between the studies, which is probably the result of differences in the applied methodology. [8][9][10] The clinical and procedural predictors of bleeding complications are not yet fully identified, and neither is their prognostic value. 3,7,8,10) Although the impact of bleeding on short-term mortality has been demonstrated, the influence on mid-term outcomes remains unclear. 11)To address the issue of heterogeneous reporting of out...

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Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis - A New Paradigm for Multidisciplinary Intervention.

Cited by 20 publications

References 0 publications

Safety and Efficacy of Implementing a Multidisciplinary Heart Team Approach for Revascularization in Patients With Complex Coronary Artery Disease

Safety and Efficacy of Implementing a Multidisciplinary Heart Team Approach for Revascularization in Patients With Complex Coronary Artery Disease

The SOURCE Registry: what is the learning curve in trans-apical aortic valve implantation?

Incidence, Predictors and Impact of Severe Periprocedural Bleeding According to VARC-2 Criteria on 1-Year Clinical Outcomes in Patients After Transcatheter Aortic Valve Implantation

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