bluuebunny/crossref_metadata_2025_split huggingface dataset:
TAVI durability
Authors: Ziviello F , Di Stefano D , Joannes F , Ancona M.B , Bellini B , Russo F , Ferri L , Carlino M , Montorfano M , Chieffo A 
Published: November 2020

Abstract

Background
TAVI (Transcatheter aortic valve implantation) is now established as the preferred treatment option for patients with symptomatic severe aortic stenosis at prohibitive or high surgical risk and its application is increasingly supported by an accumulating evidence base in patients at intermediate and low risk, but the issue of valve durability are still unsettled.

Purpose
To evaluate long-term clinical outcomes and bioprosthesis valve dysfunction after TAVI.

Methods
All patients treated with transfemoral TAVI, from November 2007 to December 2014 were analyzed. Baseline clinical, procedural and in-hospital outcomes were collected and revised. Clinical and echocardiographic follow-up was conducted either by clinic visits or telephone consultations. All definitions of the clinical endpoints and bioprosthesis valve failure used were in concordance with the Valve Academic Research Consortium 2 and the European Society of Cardiology consensus, respectively.

Results
Four hundred and eight patients were included in the analysis. Median follow-up was 2.733 days (7.5 years), with the longest follow-up at 4.096 days (11.2 years). At 7.5 years (IQR 5.4–9.3 years), all-cause mortality was 64.5% (n=263), of these cardiovascular death was adjudicated in 33.6% (n=137), non-cardiovascular death in 30.9% (n=126) and valve-related death was 1.9% (n=8). Structural valve deterioration occurred in 2.9% (n=12), non-structural valve deterioration in 0.2% (n=1), thrombosis in 2.2% (n=9) and endocarditis in 3.2% of patients (n=13). Fourteen patients (3.4%) required surgical (1.2%) or percutaneous (2.2%) aortic valve re-intervention.

Conclusions
Percutaneous aortic bioprosthesis demonstrated a low bioprosthesis valve failure at a median of 7.5 years of clinical follow-up after implantation, with low rate of degeneration or need of re-intervention. Overall mortality was high with acceptable rates of cardiovascular mortality and low rates of valve-related deaths.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): EAPCI Education and Training Grants
A novel image fusion technique to improve transseptal puncture during percutaneous mitral valve repair
Authors: Meijerink F , Wolsink I , Van Mourik M.S , Planken R.N , Boekholdt S.M , Bouma B.J , Baan J 
Published: November 2020

Abstract

Background
Percutaneous mitral valve repair (PMVR) using the MitraClip (Abbott Vascular), has gained popularity to treat mitral regurgitation (MR) in high risk patients. Accurate transseptal puncture (TSP) is a crucial step to achieve optimal guiding catheter position during the procedure.

Purpose
The aim of this study was to determine whether a planned optimal TSP site, using a novel computed tomography (CT) and echo image fusion methodology, corresponded with the actual TSP site, and if this was related to procedure time and outcome.

Methods
The mitral annulus and inter atrial septum were segmented in 26 patients (mean age 75 years, 50% female) undergoing PMVR. The optimal transseptal puncture (TSP) site was based on (1) perpendicular distance of 35–45mm from the TSP site to the mitral annulus, and (2) posterior position relative to the aorta. Optimal TSP was planned using a cardiac CT scan and 3Mensio software (Pie Medical imaging). The CT scan was exported to a Vivid E95 ultrasound system (GE Healthcare). After alignment with the three-dimensional echo image, the coordinates of the actual TSP site were determined. The distance between the optimal and actual TSP site was measured as (1) difference in height above the mitral annulus, and (2) absolute distance to the actual TSP site. Comparisons were made on procedure time, which was measured from the TSP to the achievement of optimal MitraClip position.

Results
The distance between the optimal and actual TSP site showed to be more than 5mm in 85% of the cases. The mean difference in height above the mitral annulus was 6.9mm. The mean procedure time was 21% longer when the absolute distance was more than 10mm. However, this did not reach statistical significance yet (p=0.4), likely due to small sample size.

Conclusion
CT-echo image fusion is an applicable method to plan TSP. This ongoing study suggests that image fusion based guiding may improve TSP site, reduce PMVR procedure time and potentially lead to more effective reduction of MR.
Bar chart of optimal and actual TSP site

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Abbott
Cause and risk factors for readmissions after transcatheter aortic valve replacement
Authors: Arora S , Strassle P.D , Hendrickson M.J , Sitammagari K , Qamar A , McRee C , Yeung M , Vavalle J.P 
Published: November 2020

Abstract

Background
Hospital readmissions following transcatheter aortic valve replacement (TAVR) are associated with higher costs and worse outcomes.

Purpose
Identify causes and risk factors for readmissions after TAVR

Methods
Hospitalizations of adults aged ≥50, with aortic stenosis and undergoing elective TAVR between 2012 and 2016 in the National Readmission Database were analyzed. Multivariable generalized logistic regression, adjusting for age, sex, Charleson Comorbidity Index, primary insurance type, median household income, hospital type and size, were used to assess the effect of inpatient complications, length of stay (LOS), discharge disposition, and TAVR hospital volume on 30-day cardiovascular (CV) and non-cardiovascular (non-CV) readmission.

Results
Between January 2012 and November 2016, 56,858 weighted TAVR hospitalizations were included. The most common causes of readmissions after TAVR were heart failure (23%), infection (17%), gastrointestinal (11%), respiratory (8%), and “other” non-CV causes (8%). The adjusted odds of both CV and non-CV readmissions were significantly higher in patients with acute kidney injury, inpatient LOS ≥5 days, those discharged to skilled nursing facility (SNF) and those treated at medium volume compared with high volume hospitals, Table 1.

Conclusion
Heart failure is the most common cause of readmissions after TAVR. Inpatient incidence of acute kidney injury, as well as longer LOS, SNF discharge and lower hospital TAVR volume were associated with higher odds of 30-day readmissions.

Funding Acknowledgement
Type of funding source: None
Adaptive development of concomitant secondary mitral and tricuspid regurgitation after TAVR
Authors: Winter M.P , Bartko P.E , Krickl A , Gatterer C , Nitsche C , Koschutnik M , Dona C , Spinka G , Siller-Matula J , Lang I , Mascherbauer J , Hengstenberg C , Goliasch G 
Published: November 2020

Abstract

Background
Concomitant secondary atrioventricular regurgitation is frequent in patients with severe aortic stenosis scheduled fortranscatheter aortic valve replacement (TAVR). The future implications of leaving associated valve lesions untreated after TAVR remain unknown. Aim of the present study wasto characterize the evolution of concomitant secondary atrioventricular regurgitations and to evaluate their impact on long-term prognosis.

Methods
We prospectively enrolled 429 consecutive TAVR patients. All patients underwent comprehensive clinical, laboratory, and echocardiographic assessments prior to TAVR, at discharge, and yearly thereafter. All-cause mortality was chosen as primary study endpoint.

Results
At baseline, severe concomitant secondary mitral regurgitation (sMR) was present in 54 (13%) and severe concomitant secondary tricuspid regurgitation (sTR) in 75 patients (17%). After TAVR 59% of patients with severe sMR at baseline experienced sMR regression, whereas analogously sTR regressed in 43% of patients with severe sTR at baseline. Persistence of sTR and sMR were associated with excess mortality after adjustment for our bootstrap-selected confounder model with an adjusted HR of 2.44 (95% CI 1.15–5.20, P=0.021) for sMR and of 2.09 (95% CI 1.20–3.66, P=0.01) for sTR (Figure 1). Furthermore patients showing regression of atrioventricular regurgitation exhibited survival rates indistinguishable to those seen in patients without concomitant atrioventricular regurgitation (sMR: P=0.83; sTR: P=0.74)

Conclusion
Concomitant secondary atrioventricular regurgitation in patients with severe AS is a highly dynamic process with up to half of all patients showing regression of associated valvular regurgitation after TAVR and subsequent favorable post-interventional outcome. Persistent atrioventricular regurgitation is a major determinant of TAVR futility and proposes a window of early sequel intervention.

Funding Acknowledgement
Type of funding source: None
A randomized surgical trial of mitral valve repair with leaflet resection versus leaflet preservation on functional mitral stenosis – primary results of the CAMRA CardioLink-2 trial
Authors: Chan V , Mazer C.D , Mesana T , De Varennes B.E , Gregory A.J , Bouchard D , Zuo F , Mohamad Ali F , Tsang W , Latter D.A , Juni P , Teoh H , Quan A , Leong-Poi H , Verma S 
Published: November 2020

Abstract

Background
The gold standard treatment for mitral valve regurgitation due to prolapse involves surgery with annuloplasty and either leaflet resection or leaflet preservation, with placement of artificial neochordae. It has been suggested that leaflet resection may be prone to functional mitral stenosis, whereby a patient may have a higher mitral gradient at peak exercise compared to a leaflet preservation strategy. Although both techniques are widely used, there has been no prospective randomized study conducted to compare these two techniques, particularly in regard to functional mitral stenosis.

Methods
A total of 104 patients with posterior leaflet prolapse were randomized to undergo mitral repair with either leaflet resection (N=54) or leaflet preservation (N=50) at 7 specialized Canadian cardiac centers. Patient age, proportion of female patients, and mean Society of Thoracic Surgeons risk score was 63.9±10.4 years, 19%, and 1.4% for those who underwent leaflet resection, and 66.3±10.8 years, 16%, and 1.9% for those who underwent leaflet preservation, respectively. The primary endpoint was the mean trans-mitral repair gradient at peak exercise 12-months after repair.

Results
Baseline characteristics were similar between the groups. At 12-months, the mean trans-mitral repair gradient at peak exercise in patients who underwent leaflet resection and preservation was 9.1±5.2 and 8.3±3.3 mmHg (P=0.4), respectively. The two groups had similar mean mitral valve gradient at rest (3.2±1.9 mmHg following resection and 3.1±1.1 mmHg following leaflet preservation, P=0.7). There was no between-group difference for the 6-minute walk distance (451±147 m and 481±95 m for the resection and preservation groups, respectively, P=0.3).

Conclusion
We report the first prospective surgical randomized trial to evaluate commonly used mitral valve repair strategies for posterior leaflet prolapse. Leaflet resection and leaflet preservation both yield acceptable results with no difference in postoperative valve gradient and functional status 12-months after surgical mitral valve repair.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Heart and Stroke Foundation of Canada
The mitral annulus disjunction of mitral valve prolapse: presentation and outcome
Authors: Essayagh B , Sabbag A , Antoine C , Benfari G , Maalouf J , Michelena H , Sarano M.E 
Published: November 2020

Abstract

Background
Mitral-annulus-disjunction (MAD), often described in mitral-valve-prolapse (MVP) patients, remains incompletely defined and its clinical outcome consequences are unknown.

Objectives
To assess MAD prevalence, clinical and echocardiographic characteristics, and independent impact on outcome in patients with isolated-MVP.

Methods
A cohort of 595 (65±16 years, 278 female) consecutive patients with MVP and comprehensive clinical, rhythmic and Doppler-echocardiographic characterization, was identified. Primary-endpoint was overall-survival, or occurrence of ventricular-arrhythmia. To eliminate clinical differences, we matched MAD-patients 1:1 with no-MAD based on propensity score for overall survival analysis using a greedy 5-to-1 digit-matching algorithm.

Results
MAD was frequent, present in 186 (31%) of MVP-patients and independently associated to bileaflet-MVP, leaflet-redundancy, younger-age, female-sex, enlarged left-ventricle-endsystolic-diameter and higher left-ventricle-ejection-fraction (all P≤0.04). Outcome primary-endpoint of survival after MVP diagnosis in matched-cohort (10-year 95±1%) was not associated with MAD presence (10-year 93±2% for no-MAD and 97±1% for MAD, P=0.4). Mortality was comparable for MAD (univariate-hazard-ratio 0.64 [0.25–1.65], P=0.4 vs. no-MAD), even adjusted-comprehensively including for MVP-characteristics (adjusted-hazard-ratio 1.17 [0.39–3.50], P=0.8). However, 220 (51%) MVP-patients were diagnosed ventricular-arrhythmia (161 with ventricular-tachycardia only) and long-term, MAD was associated with lower arrhythmia- and ventricular-tachycardia- overall freedom (adjusted-hazard-ratio for MAD 2.35 [1.75–3.15], P&lt;0.0001 vs. no-MAD and 2.71 [1.93–3.82], P&lt;0.0001 respectively). Hence, 10-year freedom of significant ventricular-arrhythmia in overall-cohort was severely reduced with MAD (41±4% vs. 62±3% for no-MAD).

Conclusion
In this unique MVP cohort, with arrhythmia and MAD comprehensively-characterized, MAD presence was frequent and independently associated to bileaflet-MVP and leaflet-redundancy. Long-term, MAD compared to no-MAD is not independently associated with higher-mortality but to reduced arrhythmia-freedom occurrence.
Survival overall and by V arrhythmia

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Mayo Foundation
The tricuspid annular peak systolic excursion to systolic pulmonary artery pressure index: association with all-cause mortality in patients with moderate or severe tricuspid regurgitation
Authors: Saeed S , Smith J , Grigoryan K , Lysne V , Rajani R , Chambers J.B 
Published: November 2020

Abstract

Background
In patients with significant tricuspid regurgitation (TR) the conventional markers for the assessment of right ventricular (RV) systolic function may be less accurate. Tricuspid annular plane systolic excursion (TAPSE) indexed to systolic pulmonary artery pressure (SPAP) (TAPSE/SPAP) may be prognostically useful in pulmonary hypertension and right ventricular (RV) dysfunction.

Objective
Our aim was to explore the prognostic value of TAPSE/SPAP index in patients with moderate or severe TR.

Methods
A total of 209 patients (72±14 years, 56% women) with moderate (n=123) or severe (n=86) TR (primary in 6% and secondary in 94%) were followed up for a median of 80 months (mean 70±33 months). The clinical correlates of TAPSE/SPAP ratio and association with all-cause mortality were assessed.

Results
The TAPSE/SPAP index was inversely correlated with all-cause mortality with an optimal threshold of 0.49 mm/mmHg. A low index was found in 139 (68%) patients and was associated with reduced survival (Figure). In a multivariate Cox regression analysis adjusted for age, smoking, coronary artery disease, left ventricular ejection fraction, right atrium area and mitral valve replacement, low TAPSE/SPAP index was associated with significantly higher hazard ratio of all-cause mortality (HR: 2.0; 95% CI 1.27–3.14, p=0.003). Age, coronary artery disease, left ventricular ejection fraction and right atrium area were other independent predictors of all-cause mortality.

Conclusions
The TAPSE/SPAP index, reflecting RV systolic function in the longitudinal axis corrected for force generating by the RV is a powerful predictor of all-cause mortality in patients with moderate or severe TR.
Figure 1

Funding Acknowledgement
Type of funding source: None
Inter and intraobserver variability in the echocardiographic measurement of vegetations in infective endocarditis
Authors: Lopez Diaz J , Garcia Granja P.E , Sevilla M.T , Revilla A , Vilacosta I , Olmos C , Ladron R , Gomez I , Cabezon G , San Roman J.A 
Published: November 2020

Abstract

Introduction and objectives
The indication for surgery to prevent embolism in infective endocarditis includes four clinical scenarios and three different echocardiographic measurements of the maximal vegetation diameter. These cut-off points are completely arbitrary and not evidence-based. Our hypothesis is that the vegetation diameter is not an appropriate surgical criterium. The goal of the study is to analyze the inter and intra-observer variability in this measurement and to compare the surgical indications agreement based on these parameters.

Methods
Two trained echocardiographers have measured the maximal vegetation diameter by transesophageal echocardiogram in 67 consecutive patients with definite infective endocarditis in an off-line workstation. The inter- and intra-observer variability was calculated by the interclass correlation coefficient and with the Bland-Altman analysis. The relationship between the strength of agreement for the cut-off points of 10 and 15 mm was also calculated.

Results
Intra and inter-observer interclass correlation coefficient in the measurement of the maximal longitudinal diameter of the vegetations were 0.872 (0.805–0.917) and 0.757 (0.642–0.839) respectively. The strength of agreement of the intra and inter-observer analysis for the cut-off point of 10 mm were 0.674 (0.485–0.862) and 0.533 (0.327–0.759). For the cut-off point of 15 mm they were 0.696 (0.530–0.862) and 0.475 (0.270–0.679).

Conclusions
The variability in the measurements of the maximal longitudinal diameter by transesophageal echocardiogram between two experimented echocardiographers is good. Nonetheless, surgical indications based on the cut-off points recommended in the European guidelines would have changed in an unacceptable high proportion of patients. Therefore, we suggest that these indications should be revised in the light of our results.

Funding Acknowledgement
Type of funding source: None
Long-term mortality in patients with infective endocarditis who undergo aortic root replacement versus isolated aortic valve replacement
Authors: Kyhl F , Jensen A.D , Oestergaard L , Smerup M , Dagnegaard H , Koeber L , Fosboel E.L 
Published: November 2020

Abstract

Background
Infective endocarditis (IE) with involvement of the aortic root (root abscess or aortic prosthetic valve endocarditis (PVE)) is associated with high mortality and morbidity, and it often requires root replacement. IE-guidelines recommend surgery in patients with aortic root involvement (class B recommendation), but the surgical technique is challenging, and the perioperative risk is high. Long-term data are sparse for these high-risk patients and may help better select appropriate patients for surgery.

Purpose
We set out to investigate the short- and long-term mortality for patients with destructive aortic valve endocarditis who underwent aortic root replacement. For comparison, we included those who underwent isolated aortic valve replacement for IE (isolated AVR).

Methods
We included patients with first-time IE from 2000 to 2016 who underwent aortic valve surgery identified from The Eastern Danish Thoracic surgery database. Patient characteristics were identified by cross-linking Danish nationwide databases. Patients who underwent aortic root replacement were compared with those who underwent isolated AVR. Kaplan-Meier plots and multivariable Cox regression analyses were used to estimate and compare the associated 30-days and 10-year mortality risks between groups.

Results
We included 368 patients with aortic valve IE who underwent AVR surgery; 126 patients underwent aortic root replacement and 242 underwent isolated AVR. Median age for root replacement patients was 65.4 years (interquartile range [IQR] 56.2–73.0) compared with 62.1 years (IQR 52.3–71.6) for isolated AVR patients. In the root replacement group, 40.5% had prosthetic valve endocarditis (PVE), whereas 6.6% had PVE in the isolated AVR group. 30-day mortality was 12.7% (CI95: 7.6%-19.2%) in the root replacement group and 7.0% (CI95: 4.3%-10.7%) in the isolated AVR group (P=0.06). Estimated 10-year mortality was 54.4% (CI95: 40.3%-67.6%) in the root replacement group and 45.3% (CI95: 35.7%-54.5%) (P=0.07) after isolated AVR (figure 1). At up to 10 years follow-up, there was no significant difference in adjusted mortality between the groups, adjusted HR=1.34 (CI 95: 0.90–2.00).

Conclusion
Patients with IE who underwent aortic root replacement surgery more often had a prosthetic heart valve, were older, and were more often male. There was no significant difference in long-term mortality between the groups. Nonetheless, long-term mortality was high – 50% of patients died by 10 years, and our results underline the need for stringent patient selection.
Figure 1

Funding Acknowledgement
Type of funding source: None
Genetic counselling and testing of adult patients with cardiomyopathies: insight from the EORP cardiomyopathy and myocarditis registry of the European Society of Cardiology
Authors: Helio T , Elliott P , Koskenvuo J.W , Gimeno J.G , Tavazzi L , Tendera M , Kaski P , Maggioni A , Laroche C , Caforio A.L.P , Charron P 
Published: November 2020

Abstract

Introduction
Cardiomyopathies comprise a heterogeneous group of diseases, often of genetic origin.

Purpose
We assessed the current practice of genetic counselling and testing of adult cardiomyopathy patients in the prospective ESC EORP cardiomyopathy registry.

Methods
3 208 adult patients from sixty-nine centres in 18 countries were enrolled. Clinical data on genetic counselling and testing and on the presentation of cardiomyopathies were gathered.

Results
Genetic counselling was performed in 60.8% of all patients (75.4% in hypertrophic (HCM), 39.2% in dilated (DCM), 70.8% in arrhythmogenic right ventricular (ARVC) and 49.2% in restrictive cardiomyopathy (RCM), p&lt;0.001). Comparing European geographical areas, genetic counselling was performed from 42.4% to 83.3% (p&lt;0.001). It was provided by a cardiologist (85.3%), geneticist (15.1%), genetic counsellor (11.3%), or a nurse (7.5%), (p&lt;0.001). Genetic testing was performed in 37.3% of all patients (48.8% in HCM, 18.6% in DCM, 55.6% % in ARVC and 43.6% in RCM, p&lt;0.001). Index patients with genetic testing were younger at diagnosis, had more familial disease, family history of sudden cardiac death or implanted cardioverter defibrillators but less comorbidities than those not tested (p&lt;0.001 for each comparison). At least 1 disease causing variant was found in 41.7% of index patients with genetic testing (43.3% in HCM, 33.3% in DCM, 51.4% in ARVC and 42.9% in RCM, p=0.13).

Conclusion
We report on the practice of genetic counselling and testing in cardiomyopathies in Europe. Genetic counselling and testing were performed in a substantial proportion of patients but less often than recommended by European guidelines, and much less in DCM than in HCM and ARVC, despite evidence for genetic background.

Funding Acknowledgement
Type of funding source: None