bluuebunny/crossref_metadata_2025_split huggingface dataset:
Viability and functional recovery after chronic total occlusion percutaneous coronary intervention
Authors: De Winter R , Schumacher S.P , Everaars H , Stuijfzand W.J , Van Diemen P.A , Driessen R.S , Bom M.J , Huynh J.W , Van Loon R.B , Van De Ven P.M , Van Rossum A.C , Opolski M.P , Nap A , Knaapen P 
Published: November 2020

Abstract

Background
Current guidelines advocate viability assessment to guide percutaneous coronary intervention (PCI) of chronic coronary total occlusions (CTO).

Purpose
Aim of the present study was to evaluate viability as well as global and regional functional recovery after successful CTO PCI using quantitative cardiac magnetic resonance (CMR) imaging.

Methods
132 patients with sequential CMR at baseline and 3-months after successful CTO PCI were prospectively recruited between 2013 and 2018. Segmental wall thickening (SWT) and percentage late gadolinium enhancement (LGE) were quantitatively measured per segment. Viability was defined as dysfunctional myocardium (&lt;2.84mm SWT) with no or limited scar (≤50% LGE).

Results
Significant improvements in left ventricular (LV) ejection fraction (from 48.1±11.8 to 49.5±12.1%, p&lt;0.01), LV end-diastolic volume (from 99.1±31.8 to 95.7±30.2ml, p&lt;0.01), and LV end-systolic volume (from 54.4±30.5 to 51.2±29.3ml, p&lt;0.01) were observed after CTO PCI. CTO segments with viability (N=216, (31%)) demonstrated a significantly higher increase in SWT (0.80±1.39mm) compared to CTO segments with pre-procedural preserved function (N=456 (65%), 0.07±1.43mm, p&lt;0.01) or extensive scar (LGE &gt;50%, N=26 (4%), −0.08±1.09mm, p&lt;0.01). Improvement in SWT was comparable between segments with viability if further stratified to 0, &gt;0–25, and &gt;25–50% hyperenhancement (p=0.94). Patients with ≥2 CTO segments viability showed more SWT increase in the CTO territory compared to patients with 0–1 segment viability (0.49±0.93 vs. 0.12±0.98mm, p=0.03).

Conclusions
Improvements in LV function and volumes were significant but modest following CTO PCI. Detection of dysfunctional myocardial segments without extensive scar (≤50% LGE) as a marker for viability may aid in identifying subjects with significant regional functional recovery after CTO PCI.

Funding Acknowledgement
Type of funding source: None
Sex sub analysis from observational multicenter registry of patients treated with Impella mechanical circulatory support device in Italy: the IMP-IT women
Authors: Ziviello F , Burzotta F , Briguori C , Trani C , Nicolini E , Masiero G , Pagnotta P , Pazzanese V , Scandroglio M , Piva T , De Marco F , Di Biasi M , Montorfano M , Tarantini G , Chieffo A 
Published: November 2020

Abstract

Background
Women-specific data on safety, effectiveness, and outcomes for mechanical support in the setting of cardiogenic shock (CS) and high-risk percutaneous coronary intervention (HR-PCI) are still unsettled. The IMP-IT study was a multicenter observational national registry that enrolled all patients treated with Impella 2.5, Impella CP, Impella 5.0 and Impella RP, both for CS and HR-PCI indications, across 17 Italian centers from 2004 to June 2018

Purpose
To analyze the characteristics of female population enrolled in IMP-IT registry and to assess differences in presentation, timing to interventions and outcomes between men and women.

Methods
The Women-IMP-IT study is a multicenter observational national registry focusing on female population enrolled in IMP-IT study. Baseline, procedural and hemodynamics characteristics, such as outcome were collected. Differences between men and women were examined.

Results
Mean age of female population was 66.9±16.1 years, Body mass index was 26.3±5.5 kg/m2. There was a higher rate of cardiogenic shock (66.7% vs. 49.1%; p=0.06), NSTEMI (18% vs 9%, p=0.03) and acute myocarditis (9.6% vs 1.4%, p=0.01) in women vs men, associated with a lower rate of protected PCI (33.3% vs 50.9%, p=0.06). We did not observed a statistically difference in device related complications (27.4% vs 23.3%; p=0.50), respectively in women compared to men. In particular, no differences were observed in access site bleedings (10.8% vs 9%; p=0.70) and life threatening or severe bleeding (15.3% vs 11.4%; p=0.40). At one year, all-cause death rate was 45.1% in women vs 30.1% in men (p=0.016), and cardiac death rate was 42.5% in women and 27.5% in men (p=0.013). At 1-year no significant difference was observed in the rate of myocardial infarction (3.7% vs 2.3%; p=0.44), stroke (3.7% vs 2.6%; p=0.70), heat-failure hospitalization (7.7% vs 7.5%; p=1.0), need for left ventricular assist device or heart transplantation (1.3% vs 5.5%; p=0.21).

Conclusions
In our series, use of Impella is CS and HR-PCI is increasing in female population. Sex-differences in mortality are mostly explained by clinical differences at presentation.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): EAPCI Education and Training Grants
Left ventricular assist device versus intra-aortic balloon pump for treatment of acute myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis
Authors: Yang Y.X , Wang J.X , Li X.W , Lu P.J , Bai M.N , Gao M.D , Liu Y , Gao J 
Published: November 2020

Abstract

Background
1. Despite early revascularization, the mortality of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains high.
2. Mechanical circulation support devices (MCS) are widely utilized in clinical due to unloading left ventricle and augmenting cardiac output.
3. Whether left ventricular assist device (LVAD) including TandemHeart and Impella is superior to Intra-aortic balloon pump (IABP) for AMI-CS remains unclear.

Aim
To investigate the efficacy and safety of LVAD versus IABP for AMI-CS.

Methods
1. We searched the relevant literature on PUBMED, EMBASE and Cochrane Library.
2. The primary endpoint was 30-day mortality. The secondary endpoints were in-hospital myocardial infarction (MI), stent thrombosis (ST), stroke, sepsis, major bleeding and limb ischemia.
3. Two investigators performed the studies selection and data extraction independently.
4. The quality of randomized controlled trials and observational studies was assessed by using the Cochrane Collaboration's tool and Newcastle-Ottawa Scale respectively.
5. Results were analyzed by computing pooled risk ratios (RR) with 95% Confidence Intervals (CIs).

Results
1. The process of literature search strategy is shown in Figure 1.
2. Main characteristics of the included studies can be seen in Table 1.
3. There was no significant difference in 30-day mortality (RR:0.97, 95% CI:0.80–1.17, P=0.76), in-hospital MI (RR:0.64, 95% CI:0.22–1.85, P=0.41), ST (RR:0.74, 95% CI:0.13–4.12, P=0.73), stroke (RR:1.36, 95% CI:0.37–4.94, P=0.64) and sepsis (RR:1.30, 95% CI:0.54–3.13, P=0.56) between LVAD and IABP group. However, the incidences of in-hospital major bleeding (RR:2.61,95% CI:1.61–4.23, P=0.0001) and limb ischemia (RR:4.91, 95% CI:2.07–11.64, P=0.0003) were significantly higher in LVAD than IABP group.

Conclusion
LVAD was not associated with reduced 30-day mortality but with increased in-hospital major bleeding and limb ischemia for patients with AMI-CS compared with IABP.
Figure 1

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): National 135 Key Research and Development Program in 2016
Predictive impact of PVL assessments on clinical outcomes in patients undergoing TAVR
Authors: Matsushita K , Marchandot B , Kibler M , Sato C , Heger J , Peillex M , Trimaille A , Hess S , Grunebaum L , Ohana M , Reydel A , Jesel L , Ohlmann P , Morel O 
Published: November 2020

Abstract

Introduction
Paravalvular leakage (PVL) following transcatheter aortic valve replacement (TAVR) is associated with greater mortality. In clinical practice, determining PVL severity after TAVR remains challenging and often requires multiparametric assessment.

Purpose
This study sought to evaluate the respective value of various modalities of PVL assessments, including transthoracic echocardiography (TTE), cine-angiography, aortic regurgitation index (ARI), and closure time with adenosine diphosphate (CT-ADP), in the prediction of adverse clinical outcomes.

Methods
We included 1044 patients from our prospective TAVR registry between February 2010 and May 2019. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause death, myocardial infarction, stroke, and heart failure hospitalization within 1-year. Established cutoff values of ARI (&lt;25) and CT-ADP (&gt;180 sec) were used to assess the presence of PVL after TAVR.

Results
Moderate to severe PVL occurred in 14.2% and 5.2% of patients as measured by TTE and angiography. The rate of patients with ARI &lt;25 and CT-ADP &gt;180 sec were 36.5% and 24.9%, respectively. Among the four modalities, PVL evaluated by angiography predicted poorer clinical outcomes (Log rank test; p=0.001), whereas TTE, ARI &lt;25, and CT-ADP &gt;180 sec were not associated with 1-year MACCE. By multivariate Cox regression analysis, moderate to severe PVL by angiography was an independent predictor of 1-year MACCE (hazard ratio: 1.96; 95% confidence interval: 1.22–3.00; p=0.007).

Conclusions
Paravalvular leakage measured by angiography was evidenced as the most meaningful modality in the prediction of adverse clinical outcomes. Future multicenter studies are warranted to ensure these findings in the current TAVR era.
Figure 1

Funding Acknowledgement
Type of funding source: None
Assessment of long-term structural deterioration of transcatheter aortic bioprosthetic valves
Authors: Durand E , Hemery T , Levesque T , Tron C , Litzler P.Y , Dacher J.N , Eltchaninoff H 
Published: November 2020

Abstract

Background
The durability of transcatheter aortic bioprosthetic valves is a crucial issue in the context of extension of indications in younger and lower-risk patients, but data are scarce, especially beyond 5 years of follow-up. This study sought to evaluate the incidence of structural valve degeneration (SVD) 5 to 10 years post-procedure.

Methods
Demographic, procedural, and in-hospital outcome data on patients who underwent transcatheter aortic valve implantation (TAVI) from 2002 to 2014 were obtained from our prospective institutional database. Patients in whom echocardiographic data were available both at baseline and 5 years post-TAVI were included. Clinical and echocardiographic follow-up were performed on site annually. Hemodynamic SVD was determined according to European task force committee guidelines.

Results
A total of 208 patients (82.5±7.6 years of age; 53% female) with paired post-procedure and late echocardiographic follow-up (median 5.3 years, range 5 to 11.4 years) were included. Eleven (5.3%) patients were treated with a self-expandable valve and 197 (94.7%) patients with a balloon-expandable valve. Mean aortic valve gradient and effective aortic valve area remained unchanged during follow-up. There were 2 cases (1.0%) of severe SVD 6 and 7 years after implantation requiring redo-TAVI. There were 4 cases (1.9%) of moderate SVD (mean 6.0 years post-implantation; range 5 to 7 years).

Conclusions
Our data do not demonstrate any alarm on transcatheter aortic valve durability. Careful prospective assessment in younger and lower risk patients and comparison with surgical bioprosthetic valves are required to further assess long-term durability of transcatheter valves.

Funding Acknowledgement
Type of funding source: None
Use and outcomes of emergency treatment strategies in patients with aortic valve stenosis
Authors: Piepenburg S.M , Kaier K , Olivier C , Zehender M , Bode C , Von Zur Muehlen C , Stachon P 
Published: November 2020

Abstract

Introduction and aim
Current emergency treatment options for severe aortic valve stenosis include surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty (BV). So far no larger patient population has been evaluated regarding clinical characteristics and outcomes. Therefore we aimed to describe the use and outcome of the three therapy options in a broad registry study.

Method and results
Using German nationwide electronic health records, we evaluated emergency admissions of symptomatic patients with severe aortic valve stenosis between 2014 and 2017. Patients were grouped according to SAVR, TAVR or BV only treatments. Primary outcome was in-hospital mortality. Secondary outcomes were stroke, acute kidney injury, periprocedural pacemaker implantation, delirium and prolonged mechanical ventilation &gt;48 hours. Stepwise multivariable logistic regression analyses including baseline characteristics were performed to assess outcome risks.
8,651 patients with emergency admission for severe aortic valve stenosis were identified. The median age was 79 years and comorbidities included NYHA classes III-IV (52%), coronary artery disease (50%), atrial fibrillation (41%) and diabetes mellitus (33%). Overall in-hospital mortality was 6.2% during a mean length of stay of 22±15 days. TAVR was the most common treatment (6,357 [73.5%]), followed by SAVR (1,557 [18%]) and BV (737 8.5%]).
Patients who were treated with TAVR or BV were significantly older than patients with SAVR (mean age 81.3±6.5 and 81.2±6.9 versus 67.2±11.0 years, p&lt;0.001), had more relevant comorbidities (coronary artery disease 52–91% vs. 21.8%; p&lt;0.001), worse NYHA classes III-IV (55–65% vs. 34.5%; p&lt;0.001) and higher EuroSCORES (24.6±14.3 and 23.4±13.9 vs. 9.5±7.6; p&lt;0.001) than SAVR patients. Patients treated with BV only had the highest in-hospital mortality compared with TAVR or SAVR (20.9% vs. 5.1 and 3.5%; p&lt;0.001).
Compared with BV only, SAVR patients (adjusted odds ratio [aOR] 0.25; 95% confidence interval [CI] 0.14–0.46; p&lt;0.001) and TAVR patients (aOR 0.37; 95% CI 0.28–0.50; p&lt;0.001) had a lower risk for in-hospital mortality.

Conclusion
In-hospital mortality for emergency patients with symptomatic severe aortic valve stenosis is high. Our results showed that BV only therapy was associated with highest mortality, which is in line with current research. Yet, there is a trend towards more TAVR interventions and this study might imply that balloon valvuloplasty alone is insufficient. The role of BV as a bridging strategy to TAVR or SAVR needs to be further investigated.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Heart Center Freiburg University, Department of Cardiology and Angiology I, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Early discharge after TAVI: should we still be afraid of conduction disturbances?
Authors: Ribeiro Da Silva M , Rodrigues A , Guerreiro C , Mosalina Manuel A , Santos Silva G , Teixeira P , Ribeiro Queiros P , Brandao M , Ferreira D , Caeiro D , Dias A , Sousa O , Oliveira M , Primo J , Braga P 
Published: November 2020

Abstract

Introduction
Conduction disturbances (CD) after TAVI remains the most frequent complication of the procedure, frequently increasing the length of hospital stay. A lack of consensus exists regarding in-hospital management of CD post-TAVI.

Purpose
To evaluate if an early discharge (ED) protocol could be safely implemented in patients (pts) with CD post-TAVI.

Methods
Retrospective study of all pts submitted to TAVI between 2016 and 2018. Pts with prior permanent pacemaker (PP) and non-transfemoral approach were excluded. ECG data before, immediately after the procedure and at day 3 post-TAVI were collected, and continuous telemetry monitoring was recorded. We applied a recently proposed ED algorithm (adapted from Management of Conduction Disturbances Associated With Transcatheter Aortic Valve Replacement - JACC Scientific Expert Panel; JACC 2019; 74(8):1086–106) to identify which pts could have been candidates for ED. ED was defined as discharge in the first 72 hours (h) after the procedure. We evaluated if an ED strategy would have been safe at 1-year follow-up (FUP), as defined by the absence of need for PP, syncope and mortality.

Results
242 pts were included, 44,8% males, mean age 80,4 years, mean Euroscore II 5,4 and the majority implanted a self-expandable prosthesis (64,1%). Mean hospital stay after TAVI was 7,7 days. The most frequent CD after TAVI were: new onset left bundle brunch block (36%) and high degree atrioventricular block (HAVB) (16,3%). During hospital stay 21,6% needed PP, mainly because of HAVB (mainly implanted in the first 72h).
According to the proposed algorithm, 70,7% of our pts were ED-candidates. ED-candidates had lower prevalence of predilation (18,5% vs 36,8%, p=0,008) with no significant differences between type of prosthesis or baseline ECG. ED-candidates had smaller PR interval post-TAVI (184,5 vs 202,5 ms, p=0,044) and smaller PR and QRS at 72h (p&lt;0,001 in both).
At 1-year FUP, only 2,3% of ED-candidates needed a PP (vs 37,7% non-ED, p&lt;0,001). It is noteworthy that in those ED-candidates who needed a PP during FUP, the percentage of ventricular pacing was less than 2% at 6 months. In the FUP period, 3,2% of ED candidates presented at the ER because of syncope, with no significant differences to non-ED pts. No differences between groups were found in 30-days and 1-year ER presentation because of syncope or all-cause mortality.

Conclusions
According to the proposed algorithm for ED in pts with CD post-TAVI, pts with specific ECG characteristics and without rhythm events during continuous telemetry monitoring can be early discharged with long-term safety.

Funding Acknowledgement
Type of funding source: None
Clinical outcomes after surgical or transcatheter aortic valve replacement in patients with chronic kidney disease: an analysis in 29 893 patients from the German Aortic Valve Registry
Authors: Mas-Peiro S , Faerber G , Bauer T , Bleiziffer S , Bekeredjian R , Boening A , Frerker C , Beckmann A , Moellmann H , Vasa-Nicotera M , Ensminger S , Hamm C.W , Beyersdorf F , Walther T , Fichtlscherer S 
Published: November 2020

Abstract

Background
Chronic kidney disease (CKD) is a key risk factor in patients undergoing transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR).

Purpose
We analyzed the impact of eGFR and different stages of chronic kidney disease (CKD), on short- and mid-term survival in patients undergoing TAVI or SAVR.

Methods
Data from 29893 patients enrolled in the German Aortic Valve registry (GARY) from January 2011 to December 2015 receiving TAVI (n=12834) or SAVR (n=17059) at 88 sites were included. The impact of renal impairment, as measured by eGFR and CKD stages, was investigated. The primary endpoint was 1-year cumulative all-cause mortality. A propensity score method was used to compare TAVI vs. SAVR in patients with intermediate risk and mild-to-moderate renal disease being eligible for both therapies.

Results
Higher CKD stages were significantly associated to lower in-hospital, 30-day- and 1-year survival rates. Both TAVI- and SAVR-treated patients in CKD 3a, 3b, 4, and 5 stages showed significant and gradually increasing HR values for 1-year all-cause mortality. The same trend persisted in multivariable analysis, although HR values for CKD 3a and 5 did not reach significance in TAVI patients, whereas CKD 4+5 did not reach statistical significance in SAVR. Likewise, eGFR as a continuous variable was a significant predictor for 1-year mortality, with the best cut-off points being 47.4 mL/min/1.73 m2 for TAVI and 59.8 mL/min/1.73 m2 for SAVR. Significant 8.6% and 9.0% increases in 1-year mortality were observed for every 5-mL reduction in eGFR for TAVI and SAVR, respectively. No significant differences in survival were found between TAVI and SAVR in a matched group of intermediate-risk patients potentially eligible for both therapies (HR [(95% CI] for TAVI vs SAVR 1.24 [0.76, 2.02], p=0.240).

Conclusions
CKD≥3b and CKD≥3a is an independent major risk factor for mortality in patients undergoing TAVI and SAVR, respectively. In the overall population of patients with severe aortic stenosis, an appropriate stratification based on CKD substage may contribute to a better selection of patients suitable for such therapies. TAVI and SAVR appear to achieve similar survival rates in intermediate-risk patients with moderate-to-severe renal dysfunction.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted grants by medical device companies (Edwards Lifesciences, JenaValve Technology, Medtronic, Sorin, St. Jude Medical, Symetis S.A.). Unrestricted support by funding statisticians by the DZHK (Deutsches Zentrum für Herz-Kreislaufforschung).
Next-day discharge after transcatheter aortic valve implantation
Authors: Gu Z.S , Bates-Powell J , Das R , Zaman A , Edwards R 
Published: November 2020

Abstract

Background
Transcatheter aortic valve implantation (TAVI) is being used increasingly in patients with severe symptomatic aortic stenosis. Few studies focused on hospital length of stay (LOS) and feasibility of next-day discharge.

Purpose
This study aims to evaluate the feasibility and factors associated with next-day discharge post TAVI, which can be used to help selecting suitable patients for a “fast-track” TAVI admission.

Methods
Data from all TAVI procedures conducted at our centre from January 2014 to March 2019 were collected in our local TAVI registry, and analysed retrospectively. Patients discharged within 1 day of TAVI (early discharge group) were compared with consecutive patients discharged after 24 h (late discharge group). Degree of frailty was assessed by the Canadian Study of Health and Aging (CSHA) frailty scale, and baseline functional status was assessed by Katz index of independence in activities of daily living.

Results
Of 502 patients, 274 (54.6%) were male, mean age 83.2±7.3 years, and 87 (17.7%) patients were considered frail by CSHA frailty scale. Median Katz index was 6 (i.e. functionally independent, interquartile range [IQR] 1), and mean logistic Euroscore 17.4±10.7. Percutaneous transfemoral access was performed in 468 (95.5%), and general anaesthesia was used in 64 (14.4%) patients. Early complications before discharge were comparable to national standards: death in 11 (2.3%), myocardial infarction (MI) in 1 (0.2%), permanent pacemaker (PPM) in 20 (4.3%), gastrointestinal bleed in 3 (0.6%), and tamponade in 5 (1.1%) patients. Median LOS post procedure was 2 (IQR 3), median length of total hospital stay was 3 (IQR 5). Early discharge was achieved in 213 (44.7%) patients. Multivariate logistic regression analysis showed that male gender (odds ratio [OR]: 2.81, 95% confidence interval [CI]: 1.68 to 4.7; p&lt;0.001), baseline New York Heart Association (NYHA) class below III (OR: 2.04, 95% CI 1.19 to 3.51; p=0.01) were associated with early discharge after TAVI. Furthermore, advancing age (OR: 0.96, 95% CI 0.93–0.99; p=0.02), and presence of extensive ascending aorta calcification (OR: 0.38, 95% CI 0.16–0.88; p=0.025) were associated with less probability of early discharge (i.e. presence of these features were associated with delayed discharge).

Conclusions
Next-day discharge after TAVI can be achieved in nearly half of all patients. Male younger patients with minimal symptoms at baseline (NYHA &lt; III), without feature of extensive ascending aorta calcification (porcelain aorta) are a potential suitable group to be considered for a “fast-track” next-day TAVI discharge.

Funding Acknowledgement
Type of funding source: None