Transcatheter Aortic Valve Implantation vs. Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Real-World Clinical Practice

Takeji, Yasuaki; Taniguchi, Tomohiko; Morimoto, Takeshi; Saito, Naritatsu; Ando, Kenji; Shirai, Shinichi; Sakaguchi, Genichi; Arai, Yoshinori; Fuku, Yasushi; Kawase, Yoshiaki; Komiya, Tatsuhiko; Ehara, Natsuhiko; Kitai, Takeshi; Koyama, Tadaaki; Watanabe, Shin; Watanabe, Hirotoshi; Shiomi, Hiroki; Minamino‐Muta, Eri; Matsuda, Shintaro; Yaku, Hidenori; Yoshikawa, Yusuke; Yamazaki, Kazuhiro; Kawatou, Masahide; Sakamoto, Kazuhisa; Tamura, Toshihiro; Miyake, Makoto; Sakaguchi, Hisashi; Murata, Katsuyuki; Nakai, Masanao; Kanamori, Norio; Izumi, Chisato; Mitsuoka, Hirokazu; Kato, Masashi; Hirano, Yutaka; Inada, Tsukasa; Nagao, Keisuke; Mikami, Hiroshi; Takeuchi, Yasuyo; Yamane, Keiichiro; Tamura, Takashi; Toyofuku, Mamoru; Ishii, Mitsuru; Inoko, Moriaki; Ikeda, Tomoyuki; Ishii, Katsuhisa; Hotta, Kozo; Jinnai, Toshikazu; Higashitani, Nobuya; Kato, Yoshihiro; Inuzuka, Yasutaka; Morikami, Yasuhiro; Minatoya, Kenji; Kimura, Takeshi; Investigators, K-Tavi Registry

doi:10.1253/circj.cj-19-0951

Cited by 15 publications

(9 citation statements)

References 35 publications

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“…TAVI is a new alternative to AS treatment in patients who are inoperable or have high surgical risk. Although studies have shown that the efficacy and safety of TAVI is equivalent to surgical aortic valve replacement in the general population [ 34 , 35 ], only a few studies have investigated TAVI in patients on HD [ 36 , 37 , 38 ]. The efficacy of TAVI in patients on HD will need to be elucidated in future large-scale studies.…”

Section: Discussionmentioning

confidence: 99%

Association between Serum Phosphate Levels and the Development of Aortic Stenosis in Patients Undergoing Hemodialysis

Torigoe

Kitamura

Yamaguchi

et al. 2021

JCM

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We aimed to investigate the factors associated with the development of aortic stenosis (AS) in patients undergoing hemodialysis (HD), and to elucidate the prognosis of HD patients with AS. Patients on HD that had also undergone echocardiography at Nagasaki Renal Center between July 2011 and June 2012 were included. Patients with AS at the time of inclusion were excluded. The diagnosis of AS was based on an annual routine or additional echocardiography. The patients were followed up until June 2021. The association between patient background and AS was also evaluated. Of the 302 patients (mean age, 67.4 ± 13.3 years; male, 58%; median dialysis history, 4.7 years), 60 developed AS and 10 underwent aortic valve replacement. A Cox proportional hazards model revealed that age (hazard ratio (HR), 1.07; 95% confidential interval (CI), 1.04–1.10; p < 0.001) and serum phosphate levels (HR, 1.40; 95%CI, 1.16–1.67, p < 0.001) were independent risk factors for developing AS. Incidentally, there was no significant mortality difference between patients with AS and those without (p = 0.53). Serum phosphate levels are a risk factor for developing AS and should be controlled. Annual echocardiography may contribute to the early detection of AS and improves the prognosis of patients undergoing HD.

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Section: Discussionmentioning

confidence: 99%

Association between Serum Phosphate Levels and the Development of Aortic Stenosis in Patients Undergoing Hemodialysis

Torigoe

Kitamura

Yamaguchi

et al. 2021

JCM

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“…Severe AS is associated with mortality exceeding 50% within 2 years 106 . Treatment is usually by aortic valve replacement, either via a percutaneous or surgical approach 107 .…”

Section: Depression and Valvular Diseasesmentioning

confidence: 99%

Depression and Cardiovascular Diseases

Agarwal¹

2021

ijmsci

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Cardiovascular diseases (CVD) are the leading cause of global morbidity and mortality. Besides imparting enormous human suffering and enhancing premature mortality, they also inflict huge direct and indirect financial costs on the worldwide society. With the easier availability of affordable therapeutics globally, and the relatively paucity of newer innovations, modifiable risk factors are gaining greater importance in the management of this cardiovascular epidemic. Depression is a modifiable risk factor. It is consistently and strongly associated with a higher risk of CVD incidence and mortality. CVD on the other hand, often induces the development of depression. This paper reviews the effects of depression on cardiovascular diseases.

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“…The surgical community has further questioned these because of the potential conflicts of interest and the perceived "suboptimal" outcomes for SAVR [10][11][12][13]. However, before criticizing the RCT outcome, it is essential for us to learn the accurate outcomes of our "real-world" practice in our own country, but real-world data comparing TAVR and SAVR in Japan are scarce [14]. As such, the purpose of the present study was to investigate the preoperative status and clinical outcomes of patients who underwent surgical treatment for severe AS in recent years and evaluate whether we could apply the RCT results in our daily practice.…”

Section: Introductionmentioning

confidence: 99%

Contemporary short-term outcomes of surgery for aortic stenosis: transcatheter vs. surgical aortic valve replacement

Saito

Sairenchi

Tezuka

et al. 2021

Gen Thorac Cardiovasc Surg

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Objectives This study aimed to compare the short-term outcomes of transcatheter and surgical aortic valve replacements (TAVR and SAVR) in high-, intermediate-, and low-preoperative risk patients. Methods A total of 454 patients who underwent TAVR or SAVR were included. Patients were categorized into high-, intermediate-, and low-risk according to the Society of Thoracic Surgery-Predicted Risk of Mortality score and clinical outcomes were compared between TAVR and SAVR groups. Results TAVR was less invasive, with less bleeding and transfusion (p < 0.001), less frequent new-onset atrial fibrillation (p < 0.001), and shorter intensive care unit stay (p < 0.001). Furthermore, transcatheter valves performed better than surgical valves, with lower peak velocity (p = 0.003) and pressure gradient (p < 0.001) and higher effective orifice area index (p < 0.001). The clinical outcomes of TAVR were comparable to or even superior to those of SAVR in high- and intermediate-risk patients. In low-risk patients, the 1- and 2-year mortality rates were 6.3% and 12.1%, respectively, in the TAVR group and 0% and 0.9%, respectively, in the SAVR group (p < 0.001). Mild or greater paravalvular leakage was a risk factor for mortality (hazard ratio 35.78; p < 0.001). Conclusions TAVR was superior to SAVR in the sense of less invasiveness and valvular function. However, the indication of TAVR in low-risk patients should be carefully discussed, because paravalvular leakage was a risk factor for short-term mortality.

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Transcatheter Aortic Valve Implantation vs. Surgical Aortic Valve Replacement for Severe Aortic Stenosis in Real-World Clinical Practice

Cited by 15 publications

References 35 publications

Association between Serum Phosphate Levels and the Development of Aortic Stenosis in Patients Undergoing Hemodialysis

Association between Serum Phosphate Levels and the Development of Aortic Stenosis in Patients Undergoing Hemodialysis

Depression and Cardiovascular Diseases

Contemporary short-term outcomes of surgery for aortic stenosis: transcatheter vs. surgical aortic valve replacement

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