bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revascularization of significant coronary artery disease in patients undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis
Authors: Aarts H , Van Hemert N D , Meijs T A , Van Nieuwkerk A C , Voskuil M , Delewi R 
Published: October 2022

Abstract

Background
The prevalence of coronary artery disease (CAD) in patients with severe aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI) is high. However, the importance of a percutaneous coronary intervention (PCI) prior to TAVI has been matter of debate. Importantly, patients undergoing TAVI are characterized by high age often accompanied by highly calcified coronary arteries, increasing the risk of severe periprocedural complications. Moreover, patients with a severe aortic valve stenosis are limited in their ability to compensate for these life-threatening complications. Together with the necessity of dual antiplatelet therapy after PCI, this may explain a possible negative effect of PCI in this patient population. However, there is still insufficient evidence regarding the importance of PCI in patients undergoing TAVI.

Purpose
The aim of this systematic review and meta-analysis was to assess the need for PCI in patients with significant CAD undergoing TAVI.

Methods
A systematic search was conducted to identify studies comparing optimal medical treatment only versus PCI in patients with significant CAD undergoing TAVI. Endpoints were all-cause mortality, cardiac death, stroke, myocardial infarction, and major bleeding which were assessed at 30 days, one year, and beyond one year following TAVI.

Results
A total of 14 studies was included in this meta-analysis, including 3838 patients of which 1806 patients (47.1%) underwent PCI before TAVI. All-cause mortality was not significantly different between optimal medical treatment only and PCI at 30 days (OR: 1.27; 95% CI, 0.91–1.77; p=0.17; I2=0%), at one year (OR: 0.91; 95% CI, 0.64–1.29; p=0.59; I2=45%), and beyond one year (OR 0.68; 95% CI, 0.42–1.08; p=0.10; I2=49%). Cardiac death and myocardial infarction was similar across the groups at 30 days (OR cardiac death: 1.94; 95% CI, 0.36–10.56; p=0.45; I2=28%; OR myocardial infarction: 0.50; 95% CI, 0.13–1.91; p=0.31; I2=0%), and at one year (OR cardiac death: 0.77; 95% CI, 0.19–3.13; p=0.72; I2=84%; OR myocardial infarction: 0.74; 95% CI, 0.21–2.66; p=0.64; I2=18%). Stroke did not significantly differ between PCI and optimal medical treatment groups at 30 days (OR: 0.77; 95% CI, 0.31–1.92; p=0.57; I2=0%). However, patients that underwent TAVI without preceding PCI had significantly lower risk of major bleeding at 30 days (OR: 0.66; 95% CI, 0.46–0.94; p=0.022; I2=0%).

Conclusion
This systematic review and meta-analysis showed no significant differences in clinical outcomes between patients with and without PCI prior to TAVI at both short- and long-term follow-up, apart from a higher risk of major bleeding within 30 days in patients undergoing PCI before TAVI.

Funding Acknowledgement
Type of funding sources: None.
Early results of rapid-deployment aortic prosthesis in multivalvular surgery – a propensity score matching
Authors: Carvalho Guerra N , Velho T , Pereira R M , Reis I , Nobre A 
Published: October 2022

Abstract

Background
Multivalvular surgery (MV) requires prolonged extracorporeal circulation (ECC) and aortic cross-clamp times (X-Ao). Rapid-deployment aortic prosthesis (RD-AV) allow lower ECC and X-Ao times in isolated aortic valve surgery (AVR), but have not been studied in MV surgery.

Purpose
To determine if RD-AV use influences early outcomes when compared to biological stented or mechanical aortic valves in MV surgery.

Methods
Retrospectively collected pre, intra and immediate post-operatory data on all MV adult patients with AVR operated on our Department from January 2016 to February 2022. Bentall surgery and aortic dissection patients were excluded. A propensity score matching (PSM) of patients receiving RD-AV (Group A) compared to patients with non-RD-AV (Group B) was performed using sex, age, Euroscore II, type of surgery (involved valves, CABG, ascending aortic replacement), active endocarditis, ventricular function and redo surgery. After PSM, we compared outcomes until death or discharge. Normal distribution of samples was tested using the Kolmogorov-Smirnov test. Normal data was analysed with unpaired t-testing and non-normal data with non-parametric Mann Whitney U test. Categorical data were analysed with Fisher test. A significance level of p&lt;0.05 was accepted.

Results
205 patients received non-RD-AV and 58 patients RD-AV. After PSM, 57 pairs of patients were obtained. Sex, BMI, Euroscore II, age, redo surgery, insulin dependent DM, baseline creatinine, left ventricle ejection fraction, right ventricle dysfunction, pulmonary artery systolic pressure, and active endocarditis were similar in both groups. Intra-operatory, RD-AV valves (Group A) were associated with shorter surgery duration (167.3±52 vs 206.6±91 min, p=0.005), shorter ECC duration (89.5±36.5 vs. 118.9±56.5 min, p=0.002), and aortic X-clamp time (71.6±28 vs. 98.9±38.2 min, p&lt;0.001). No differences were found between both groups A vs. B in ventilation time (1270±1911 vs. 2428±5627 min, p=0.59), inotropic support (113±178 h vs. 85±101 h, p=0.38), transfusion of red cells units (1.1±1.6, vs. 1.2±1.7, p=0.73), Fresh frozen plasma units (0.86±1.9, vs. 0.77±1.8, p=0.77), platelet pools (0.79±1.0 vs. 0.7±0,9, p=0.67), fibrinogen (0.77±1.5 vs. 0.75±1.4 g, p=0.98), intra-aortic balloon pump use (5 vs. 12 patients, p=0.11), chest drain output (804±656 vs. 825±992 ml, p=0.69), new-onset dialysis (10 vs. 10 patients, p=1.0), new-onset atrial fibrillattion (10 vs 13 patients, p=0.6) and permanent pacemaker implantation (8 vs. 3 patients, p=0.20). Total ICU stay (9.25±21 vs. 4.5±4 days, p=0.3), hospital stay (14.4±26 vs. 10.1±13 days, p=0.52) and intra-hospital mortality (7 vs 9 patients, p=0.79) were also similar.

Conclusion
Despite shorter surgery duration, ECC duration and aortic X-clamp duration, RD-AV have similar early outcomes when compared with non-RD-AV in multivalvular surgery.

Funding Acknowledgement
Type of funding sources: None.
The long-term effect of surgical aortic valve replacement on arterial stiffness and wave reflections
Authors: Sigala E , Terentes-Printzios D , Baikoussis G N , Katsaros A , Koumallos N , Lozos V , Giakis N , Filis K , Tsioufis K , Vlachopoulos C 
Published: October 2022

Abstract

Background
Assessing arterial properties in patients with aortic valve stenosis undergoing surgical aortic valve replacement (SAVR) is difficult, and the results to date have been inconclusive.

Purpose
We sought to investigate how SAVR affects vascular stiffness in the short and long term.

Methods
We included 69 patients (mean age 70.8±8.4 years, 62% men) with severe symptomatic aortic stenosis who underwent SAVR. Arterial stiffness was assessed using the carotid femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV). Measurements in patients with an ankle-brachial index (ABI) &lt;0.9 were excluded from the analysis for baPWV measurments because a low ABI can affect the accuracy of baPWV. Augmentation index corrected for heart rate (Alx@75), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, in the acute phase and 1 year after the operation.

Results
Immediately after SAVR there was an increase in cfPWV (8.04±1.3 m/s vs 8.54±1.6 m/s, p=0.02) that was sustained at 1 year (8.04±1.3 m/s vs 9.42±2.4 m/s, p≤0.001). Similarly, baPWV (n=55) increased in the acute phase (1633±429 cm/s vs 2014±606 cm/s, p&lt;0.001) and persisted 1 year postoperatively (1633±429 cm/s vs 1867±408 cm/s, p&lt;0.001). Post-SAVR we also observed a decrease in Alx@75 (31.02±10% vs 22.73±12%, p≤0.001) that was attenuated 1 year later (31.02±10% vs 26.65±8%, p≤0.001), and an increase in SEVR (136.1±30.4% vs 149.2±37.7%, p=0.01) which remained improved at 1 year (136.1±30.4% vs 147.5±30.4%, p=0.01).

Conclusions
After SAVR the arterial system shows an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term.

Funding Acknowledgement
Type of funding sources: None.
Predictors of short and long-term mortality after surgical aortic valve replacement in 681 octogenarians: a monocentric experience
Authors: Mistiaen W P , Deblier I , Dossche K , Vanermen A 
Published: October 2022

Abstract

Introduction
In spite of potential frailty, very elderly patients are increasingly referred for surgical aortic valve replacement (SAVR), even after the introduction of transcatheter aortic valve implantation.

Purpose
What are the predictors for short and long-term mortality after surgical aortic valve replacement in octogenarians and are these avoidable?

Patients and methods
This is a retrospective file study of 861 octogenarians, who underwent SAVR with or without associated procedures between 1987 to 2017. Mechanical valves and valves in another position were excluded. Age, gender, cardiac and non-cardiac comorbid conditions (renal, pulmonary, diabetes, malignancy), operative data (cross-clamp and bypass time, associated procedures) and postoperative adverse events were investigated for their effect on 30-day and on long-time mortality. Significant factors in an univariate analysis (chi-square and Kaplan-Meier) were entered in a multivariate model (logistic regression, Cox' proportional hazard analysis).

Results
Hospital mortality was 68/681 (10%). The follow-up was 3817 years, with a mean of 6.2 years for the remaining 613 patients. Predictors (Odds Ratio, p-value) for hospital mortality are:
– Need for SAVR &lt;24h, 3.87 (p=0.001)
– Pulmonary disease, 2.44 (p=0.002)
– Atrial fibrillation, 2.30 (p=0.004)
– Age &gt;85 years, 2.02 (p=0.021)
– Renal disease, 1.94 (p=0.025)
– Coronary artery disease, 1.99 (p=0.046)
Five-year survival is 66.4±1.9% (392 patients at risk); ten-year survival is 25.3±2.0 (89 patients at risk), 15-year survival is 4.0±1.3% (6 patients at risk). Its predictors (Odds Ratio, p-value) are:
– Renal disease, 1.40 (p=0.005)
– Congestive heart failure, 1.37 (p=0.006)
– Postoperative Low Cardiac Output Syndrome, 1.82 (p=0.007)
– Postoperative delirium, 1.45 (p=0.010)
– Postoperative ventricular arrhythmia 1.84, (p=0.014)
– Need for SAVR &lt;24 h, 1.69 (p=0.021)
– Diabetes mellitus, 1.30 (p=0.032)
– Malignancy, 1.30 (p=0.046)
– Pulmonary disease, 1.26 (p=0.047)
– Preoperative carotid artery endarterectomy, 1.49 (p=0.052)

Conclusions
In this elderly population, short and long-term mortality are acceptable. The need for urgent SAVR (&lt;24h) is the dominant predictor for 30-day mortality. Of the ten predictors for long-term survival, seven are of preoperative nature. Two postoperative cardiac events as well as need for urgent SAVR have an important effect on long-term outcome. No operative variables were identified as predictor. Need for urgent SAVR should be avoided by early referral.

Funding Acknowledgement
Type of funding sources: None.
Temporal changes in aortic valve replacement according to age in Denmark: nationwide data from 2008 to 2020
Authors: Graversen P L , Butt J H , Oestergaard L , Jensen A D , Warming P E , Strange J E , Moeller C H , Schou M , Backer O D , Koeber L , Fosboel E L 
Published: October 2022

Abstract

Background
Since the introduction of transcatheter aortic valve implantation (TAVI), the management of symptomatic severe aortic stenosis has changed. Recent published European guidelines (2021) favours TAVI over surgical aortic valve replacements (SAVR) in patients with older age (≥75 years of age) or patients with high surgical risk. The study of nationwide practice patterns for AVR is important and renders the possibility to evaluate whether clinical practice differs from current guidelines.

Purpose
To evaluate temporal changes in use of isolated aortic valve replacement (AVR) procedures according to age in the era of TAVI in Denmark.

Methods
We identified all first-time aortic valve replacement procedures (TAVI or SAVR) from 2008 until the end of 2020 through administrative registries in Denmark. Patients with no prior diagnosis of aortic stenosis at time of AVR were excluded. Patients with prior AVR or valve repair were excluded. SAVR was divided according to type of prostheses: surgical bioprostheses and mechanical prostheses. To evaluate changes according to age the study cohort was divided into two age groups: &lt;75 and ≥75 years of age.

Results
Between 2008 and 2020, 12,313 first-time isolated AVR procedures were performed in Denmark. Volume of isolated AVR increased from 621 to 1256 procedures per year (ptrend &lt;0.001). Isolated SAVR was performed in 6,548 patients (53.2%) and TAVI in 5,765 patients (46.8%). Median age of TAVI patients was 81.4 [76.9–85.2] years of age compared to 73.1 [68.0-≥77.7] in patients receiving surgical bioprostheses and TAVI patients had a higher degree of comorbidity (TAVI: 70% of patients with Charlson comorbidity score ≥1, surgical bioprostheses: 50% of patients with Charlson comorbidty score ≥1). TAVI increased during study period compared to isolated SAVR, where a decreasing trend was observed from 2014 and onwards. In &lt;75-year-old patients, volume of TAVI significantly increased during study period (ptrend&lt;0.001), whereas volume of surgical bioprostheses remained stable. Volume of mechanical prostheses decreased over time (ptrend &lt;0.001) TAVI increased in ≥75-year-old patients (ptrend &lt;0.001) and TAVI accounted for 91.5% of all isolated AVR procedures in 2020. In contrast, volume of isolated SAVR declined driven by a decreasing use of surgical bioprostheses (ptrend=0.001). (Figure 1).

Conclusions
Volume of isolated aortic valve replacement (AVR) doubled from 2008 and 2020. The increase in isolated AVR was driven by transcatheter aortic valve implantation (TAVI). TAVI has become the predominant choice of isolated AVR in management of aortic stenosis and our results suggest that real-world practise patterns are in line with current guideline recommendations.

Funding Acknowledgement
Type of funding sources: None.
Dynamics of sympathetic nerve activity in patients with functional tricuspid regurgitation and its postinterventional progression
Authors: Ozturk C , Ozkan N , Vogelhuber J , Nickenig G , Weber M U , Hammerstingl C 
Published: October 2022

Abstract

Background
Increased muscle sympathetic nerve activity (MSNA) is associated with poor prognosis in patients with chronic heart failure (CHF). The improving effect of interventional therapy of mitral regurgitation (MR) and aortic stenosis on MSNA in patients with CHF has been previously shown.

Purpose
MSNA in patients with functional tricuspid regurgitation (FTR) has not been evaluated yet, and the effect of transcatheter tricuspid valve repair (TTTVR) on MSNA is unknown.

Methods
We prospectively included 28 patients with ≥ severe FTR who underwent TTVR. All patients were followed up at the earliest 12 months after the procedure. Microneurography was performed to determine MSNA, as described previously. Tungsten needles (200 μm) were used to record multiunit postganglionic sympathetic activity from the nervus peroneus longus close to the caput fibuli. There are two MSNA-defining parameters – burst frequency (burst/min) and burst incidence (burst/beats). In 9 patients, it was possible to perform microneurography at follow-up.

Results
28 patients (80.7±5.2 years, 53.6% female) with symptomatic (100% NYHA≥ II) high-grade FTR (severe TR: 78.6%, massive TR: 14.3%, torrential TR 7.1%) were prospectively included. At baseline, we documented preserved left ventricular function with a LVEF of 57.7±10.9%, however impaired right ventricular function (TAPSE: 15.8±5.2 mm) with biatrial dilation (left atrial volume: 95.4±40.7 ml, right atrial area: 31.8±10.8 cm2. Baseline NT pro-BNP was 2659.3±2214.3pg/dl. There was no relevant MR at baseline (MR ≤ moderate). According to baseline microneurography, we found a significantly increased MSNA (incidence: 146.16±65.85 bursts/beats, frequency: 182.21±140.6 bursts/min). Furthermore, MSNA was significantly and negatively correlated with renal function at baseline (MSNA incidence r=−0.67, p=0.0001; MSNA frequency r=−0.40, p=0.034). On the other hand, the serum level of NT pro-BNP showed a positive and significant correlation with MSNA incidence (r=0.64, p=0.0004), however no relevant association with MSNA frequency (r=0.23, p=0.24). The procedural success was 96.4%. One procedure was interrupted due to irreducible TR. At FU, we found sustained TR reduction (81.4% TR

Conclusion
We documented increased sympathetic nerve activity in patients with FTR. Renal function inversely correlates with all MSNA-defining parameters, and MSNA incidence shows a positive correlation with levels of NT-pro BNP. TTVR decreases MSNA, which might be regarded as an additional neurological pathway of postinterventional clinical improvements apart from intracardiac volume and pressure changes.

Funding Acknowledgement
Type of funding sources: None.
CT-determined tricuspid annular dilatation is associated with persistence of tricuspid regurgitation after transcatheter aortic valve replacement
Authors: Loew K , Steffen J , Theiss H , Orban M , Rizas K , Hagl C , Massberg S , Hausleiter J , Braun D , Deseive S 
Published: October 2022

Abstract

Introduction
Moderate or severe tricuspid regurgitation (TR) can be observed in 11% to 27% of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). Even though in most patients an improvement of TR can be achieved after TAVR, the persistence of severe or massive TR after the procedure is associated with increased all-cause mortality.

Purpose
The aim of this study was to investigate if tricuspid annular dilatation (TAD) measured in pre-procedural CT among TAVR patients who had at least moderate TR at baseline could serve as a predictor for the persistence of TR. Moreover, the predictive value of TR persistence on the composite of 2-year mortality or tricuspid valve intervention was analysed.

Methods
We examined 151 patients with severe AS and at least moderate concomitant TR at baseline, who were treated with TAVR from April 2013 to December 2019. TR persistence was defined as the same or a higher grade of TR in the follow-up echocardiography at least 30 days after the procedure compared to preprocedural TR grade. To identify patients with TAD, the maximum septolateral diameter of the tricuspid annulus was measured in pre-procedural cardiac computed tomography images and normalized to the body surface area.

Results
The median value of 25.5 mm/m2 was determined as cut-off value for TAD. Out of 151 patients with moderate or more TR before TAVR, 75 patients (49.7%) were above the threshold of 25.5 mm/m2. Improvement of TR after TAVR of at least one grade was significantly more frequent in patients without TAD than with TAD (59% vs. 32%, corresponding odds ratio for persistence of TR: 3.06, 95% confidence interval: 1.50–6.35, p=0.001) (Figure 1A). Multivariable logistic regression analysis with adjustment for baseline TR severity confirmed that the predictive value of TAD for TR persistence after TAVR was irrespective of baseline TR (adjusted odds ratio: 2.79, 95% confidence interval: 1.42–5.59, p=0.003). Tricuspid valve intervention was conducted in 11 patients with TAD after TAVR (14.6%) and in no patients without TAD. Accordingly, at 2-years, tricuspid valve intervention-free survival was lowest among patients with TAD and persistent TR (Figure 1B).

Conclusion
Our analysis demonstrates for the first time that in patients undergoing TAVR for severe AS and at least moderate concomitant TR, CT-derived TAD is associated with persistence of TR after the procedure. Furthermore, TR persistence is associated with an adverse outcome.

Funding Acknowledgement
Type of funding sources: None.
The impact of right atrium and left atrium reverse remodeling for functional regurgitation of atrioventricular valve among patients who were underwent ablation for atrial fibrillation
Authors: Nemoto N , Samejima Y , Takenaka H , Yaguchi T , Kameda Y , Shimizu T , Sahara N , Takenaka H , Nagashima Y , Anzai H 
Published: October 2022

Abstract

Background
Atrial fibrillation (AF) is a risk factor of Regurgitation of Atrioventricular Valve and Regurgitation of Atrioventricular Valve is improved after ablation for AF. However, Mechanism of improvement of Tricuspid regurgitation (TR) and Mitral regurgitation (MR) after ablation for AF were unclear.

Methods
The one hundred fifty-seven cases consecutive patients who were underwent ablation for persistent AF were examined in this study. These patients were performed Holter ECG and Echocardiography 6 months after ablation for persistent AF. The area of the Right Atrium (RA), Left Atrium (LA), diameter of the tricuspid valve anulus and Mitral valve annulus, were measured by echocardiography at before and 6 months after ablation for AF. The reverse remodeling index (RRI) was defined as divided post area of RA and LA by pre area of RA and LA. The Improved group was defined as one or more than regurgitation grade improvements.

Results
TR improved in 56 cases (35.7%) of 157 cases and MR improved in 25 (16.6%) cases of 157 cases. The ratio of improved TR was significantly higher than ratio of improved MR (p&lt;0.01). The difference in tricuspid annulus diameter before and after ablation for AF was significantly longer in TR improved group than in TR non-improved group. (4.9±5.3 mm vs 1.6±5.4 mm, p&lt;0.01). The RRI of RA in TR improved group was significantly smaller than in TR non-improved group (0.73±0.19 vs 0.89±0.26 p&lt;0.01). The difference in mitral annulus diameter before and after ablation for AF was not significant differences between MR improved group and MR non-improved group. The RRI of LA in MR improved group was significantly smaller than in MR non-improved group (0.79±0.22 vs 0.90±0.25 p&lt;0.01). The RRI of RA was significantly smaller than RRI of LA among patients who were able to maintain sinus rhythm after ablation for persistent AF (0.79±0.23 vs 0.85±0.24 p=0.04).

Conclusion
Reverse remodeling of RA was higher than Reverse remodeling of LA among patients who were able to maintain sinus rhythm after ablation for persistent AF and Reverse remodeling of RA and LA were important factors of improvement of TR and MR after ablation for persistent AF. These results considered to be the cause why the improvement rate of TR was higher than the Improvement rate of MR after persistent AF.

Funding Acknowledgement
Type of funding sources: None.