Transcatheter aortic valve implantation in the patients with chronic liver disease

Ma, Xiaochun; Zhao, Diming; Li, Jinzhang; Wang, Dong; Zhang, Jianlin; Yuan, Peidong; Kong, Xiangqian; Ma, Jiwei; Ma, Huibo; Sun, Liangong; Zhang, Yuman; Jiao, Qiqi; Wang, Zhengjun; Zhang, Haizhou

doi:10.1097/md.0000000000019766

Cited by 9 publications

(6 citation statements)

References 34 publications

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“…Similarly, due to associated coagulopathy, liver disease patients have an increased tendency to bleed [27]. In a previous meta-analysis, patients with chronic liver disease had a higher incidence of bleeding complications, need for blood transfusions, and mortality, which was further exacerbated by antiplatelet drug use [28,29]. As reported by Tchetche et al, 38.9% of patients undergoing TAVR received at least one transfusion [10,13,19,29].…”

Section: Discussionmentioning

confidence: 92%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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BackgroundTranscatheter aortic valve replacement (TAVR) is now a common procedure to treat and improve quality of life, clinical outcomes, and self-sufficiency in high-risk patients with aortic stenosis, and its use has been expanding rapidly in younger and low-risk populations. The aim of this study was to evaluate the outcomes, trends, and predictors of major bleeding in patients undergoing TAVR. MethodologyWe utilized the National Inpatient Sample (NIS) data from the year 2015 to 2018. International Classification of Disease 10 codes were utilized to extract data. Baseline characteristics were compared using Pearson's chisquare test for categorical variables and independent samples t-test for continuous variables. A multivariable logistic regression model was used to evaluate the predictors of major bleeding. Propensity matching was done for adjusted analysis to compare outcomes in TAVR with and without major bleeding. The outcomes of interest in this study were (1) predictors of major bleeding after TAVR; (2) in-hospital mortality; and (3) resource utilization in terms of cost and length of stay. ResultsA total of 34,752 weighted hospitalizations for TAVR were included in the analysis. Of the patients undergoing the procedure, 2,294 (6.6%) had a major bleed while 32,458 (93.3%) did not. At baseline, patients with coagulopathy (odds ratio [OR]: 2.03; 95% confidence interval [

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Section: Discussionmentioning

confidence: 92%

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Khan¹,

Gilani²,

Qayum³

et al. 2021

Cureus

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“…On review, we found 40 previous meta‐analyses discussing the risk factors of PPM implantation, however in light of the current evidence the applicability of those studies is limited. 92 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 Most of these meta‐analyses included a smaller number of previously published studies ranging from 4 to 41 articles, missing a large amount of contemporary data. The selection criteria and measured predictors were limited with respect to conduction abnormalities evaluated, indications for TAVR, and in some incidences inclusive of SAVR patients.…”

Section: Discussionmentioning

confidence: 99%

“… References 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 …”

Section: Supporting Informationunclassified

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

Ullah

Zahid

Zaidi

et al. 2021

JAHA

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Background As transcatheter aortic valve replacement (TAVR) technology expands to healthy and lower‐risk populations, the burden and predictors of procedure‐related complications including the need for permanent pacemaker (PPM) implantation needs to be identified. Methods and Results Digital databases were systematically searched to identify studies reporting the incidence of PPM implantation after TAVR. A random‐ and fixed‐effects model was used to calculate unadjusted odds ratios (OR) for all predictors. A total of 78 studies, recruiting 31 261 patients were included in the final analysis. Overall, 6212 patients required a PPM, with a mean of 18.9% PPM per study and net rate ranging from 0.16% to 51%. The pooled estimates on a random‐effects model indicated significantly higher odds of post‐TAVR PPM implantation for men (OR, 1.16; 95% CI, 1.04–1.28); for patients with baseline mobitz type‐1 second‐degree atrioventricular block (OR, 3.13; 95% CI, 1.64–5.93), left anterior hemiblock (OR, 1.43; 95% CI, 1.09–1.86), bifascicular block (OR, 2.59; 95% CI, 1.52–4.42), right bundle‐branch block (OR, 2.48; 95% CI, 2.17–2.83), and for periprocedural atriorventricular block (OR, 4.17; 95% CI, 2.69–6.46). The mechanically expandable valves had 1.44 (95% CI, 1.18–1.76), while self‐expandable valves had 1.93 (95% CI, 1.42–2.63) fold higher odds of PPM requirement compared with self‐expandable and balloon‐expandable valves, respectively. Conclusions Male sex, baseline atrioventricular conduction delays, intraprocedural atrioventricular block, and use of mechanically expandable and self‐expanding prosthesis served as positive predictors of PPM implantation in patients undergoing TAVR.

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“…Careful attention to dimensionless index, cross-sectional appearance of the valve, and further evaluation with left/right heart catheterization or TEE should be considered in patients with moderate or greater aortic stenosis. We consider TAVR in all patients prior to listing with severe aortic stenosis or moderate aortic stenosis with symptoms, as there are emerging data that TAVR can be performed safely in this population [24 ▪ ]. Echocardiography should be obtained when patients are euvolemic, as volume overload will worsen the degree of mitral and tricuspid regurgitation.…”

Section: Valvular Diseasementioning

confidence: 99%

Cardiac evaluation of the liver transplant candidate

Possick,

Khungar,

Deshpande

2023

Current Opinion in Organ Transplantation

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Purpose of review This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure. Recent findings Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients. Summary Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.

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Transcatheter aortic valve implantation in the patients with chronic liver disease

Cited by 9 publications

References 34 publications

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

An Analysis of the Predictors of Major Bleeding After Transcatheter Aortic Valve Transplantation Using the National Inpatient Sample (2015–2018)

Predictors of Permanent Pacemaker Implantation in Patients Undergoing Transcatheter Aortic Valve Replacement ‐ A Systematic Review and Meta‐Analysis

Cardiac evaluation of the liver transplant candidate

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