Aortic Stenosis In High-risk Patients Research Articles

Role of computed tomography as a preprocedural evaluation tool in transcatheter aortic valve replacement

Abstract Transcatheter aortic valve replacement (TAVR) is increasingly becoming the preferred innovative approach for high-risk aortic stenosis patients. However, before undergoing TAVR, it is crucial to undergo a noninvasive and accurate assessment for proper valve sizing and planning the access route. Computed tomography (CT) imaging plays a vital role in evaluating patients scheduled for transcatheter aortic valve implantation (TAVR). It offers comprehensive information about the aortic valve complex anatomy and the preferred access route, ensuring effective patient selection, and guiding the selection of the appropriate prosthesis. In addition, CT imaging aids in determining the fluoroscopic projection angle, leading to reduced procedural time and optimized use of contrast and radiation exposure.

S2910 Transcatheter Aortic Valve Replacement Restoring Candidacy for Liver Transplant in Cirrhotic Patients

Introduction: Current guidelines for preoperative workup for an orthotopic liver transplant (OLT) recommend echocardiogram and cardiac testing that classically rule-out patients with superimposed severe aortic stenosis as transplant candidates. We evaluated the potential of transcatheter aortic valve replacement (TAVR) as a bridging therapy to restore the candidacy of cirrhotic patients with severe AS for liver transplant. Case Description/Methods: A retrospective chart review was performed on 472 patient records that underwent liver transplants at a single large tertiary care center between 2017 and mid-2021. We identified patients who had a history of severe aortic stenosis corrected by TAVR. We extracted demographic and long-term outcome data. Two patients underwent the TAVR procedure which alleviated AS and allowed for reinstatement of eligibility for OLT. Evaluation at 1-month, 3-months and 1-year post-liver transplant showed no complications in the function of or related to the prosthetic aortic valves. Patient survival at 1 year and 2 years post-transplant was 100%. Mean time of follow-up post-transplant was 27 months. Graft survival at 1 year and 2 years was 100% with no evidence of rejection. Both 1 year and 2-year follow-up labs showed that patients were normotensive and had lipid profiles within the normal range. One of the patients had baseline high HbA1c consistent with their history of type 2 diabetes that continued to show in their follow-up labs while the other had normal glucose and HbA1C throughout. Noteworthy post-transplant complications included a left lower quadrant hematoma in one patient which resolved spontaneously and alcoholic recidivism managed through transplant psychiatry care. One patient did have a left-sided facial droop and right-sided pronator drift two days following the liver transplantation. CTA showed 74% stenosis of the right ICA and MRI confirmed hypoxic ischemia. Facial droop and drift resolved upon revaluation a few hours after onset. (Table) Discussion: In the setting of these growing contraindicated problems of AS and liver cirrhosis, we wanted to contribute to the currently scarce compilation of case reports that illustrates the effect that the TAVR procedure has on relieving the pre-transplantation risks of aortic stenosis in high-risk patients. The patients do have the potential for other cardiovascular diseases long-term and should be monitored closely with modification of risk factors. Table 1. - This is a comparison of echocardiogram parameters of aortic valve morphology and function for both patients #1 and #2 before and after TAVR as well as after OLT Parameters Patient #1 Patient #2 Before TAVR After TAVR After OLT Before TAVR After TAVR After OLT Aortic valve peak gradient (mmhg) 16.9 12.2 16.6 67.7 51.4 50.0 Aortic valves mean gradient (mmhg) 8.4 5.8 9.8 38.3 24.5 25.5 Left ventricular ejection fraction (%) 61 46 55 >70 67 63 Aortic valve area, Vmax (cmÂ2) 2.22 1.53 3.12 0.92 0.98 1.18 The post-TAVR parameters occurred 2 days after the procedure for patient #1 and <6 months for patient #2 due to care referral to our offices. The post OLT echo parameters were measured two months after patient #1's transplant and 4 days after patient #2 transplant.

Prognostic value of nutritional and inflammatory scores in Transcatheter aortic valve replacement patients

Background: Aortic Stenosis (AS) is a common heart valve disease that especially affects the elderly population and is seen with the aging of the society. In recent years Transcatheter aortic valve replacement patients (TAVR) has been increasingly applied worldwide as a procedure for the treatment of severe AS. Recently, various biomarkers and derived marker approaches have been studied in AS patient groups as in many cardiovascular diseases. Since it has been previously shown that increased inflammatory scores and poor nutritional scores are closely associated with the development process and prognosis of cardiovascular diseases, we hypothesized that these scores may be associated with prognosis after TAVR. Therefore, in this study, we aimed to make a detailed evaluation in terms of mortality determinants after TAVR.&#x0D; Methods and Results: 118 TAVR patients were included in the analysis. Median follow-up of 118 patients was 40.5 months. In terms of inflammatory status scores, the systemic immune inflammatory (SII) score (p= 0.027), the neutrophil/lymphocyte ratio (NLR) score (p= 0.012), and the platelet/lymphocyte ratio (PLR) score (p= 0.012) in the death group was found to be significantly higher. As nutritional status scores, the prognostic nutritional index (PNI) score (p= 0.003) was lower in the death group and the median Controlling Nutritional Status (CONUT) score (p= 0.002)) found significantly higher.&#x0D; Conclusion: In severe and high-risk AS patients undergoing TAVR, measurement of malnutrition with the CONUT score and increased inflammatory status with the SII score was associated with an increased risk of all causes mortality in long-term follow-up. It has been determined that the development of complications related to the procedure is an indicator of increased mortality not only in the short term but also in the long-term follow-up.

Clinical outcomes of patients with hepatic insufficiency undergoing transcatheter aortic valve implantation: a systematic review and meta-analysis

BackgroundTranscatheter aortic valve implantation (TAVI) is currently a common treatment in high-risk aortic stenosis patients, but the impact of hepatic insufficiency on prognosis after TAVI is debatable and whether TAVI is superior to surgical aortic valve replacement (SAVR) in patients with hepatic insufficiency is uncertain.ObjectiveTo investigate the effect of abnormal liver function on the outcome and safety after TAVI and whether TAVI is superior to SAVR in patients with hepatic insufficiency.MethodsPubMed, Embase, the Cochrane Library and Web of Science were systematically searched from inception up to 26 November 2021. Studies were eligible if mortality and complications after TAVI in patients with and without hepatic insufficiency, or mortality and complications for TAVI versus SAVR in patients with hepatic insufficiency were reported. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of each study. This meta-analysis was registered with PROSPERO (CRD42021253423) and was carried out by using RevMan 5.3 and Stata 14.0.ResultsThis meta-analysis of 21 studies assessed a total of 222,694 patients. Hepatic insufficiency was associated with higher short-term (in-hospital or 30-day) mortality [OR = 1.62, 95% CI (1.18 to 2.21), P = 0.003] and 1–2 years mortality [HR = 1.64, 95% CI (1.42 to 1.89), P < 0.00001] after TAVI. Between TAVI and SAVR in patients with hepatic insufficiency, there was a statistically significant difference in in-hospital mortality [OR = 0.46, 95% CI (0.27 to 0.81), P = 0.007], the occurrence rate of blood transfusions [OR = 0.29, 95% CI (0.22 to 0.38), P < 0.00001] and the occurrence rate of acute kidney injury [OR = 0.55, 95% CI (0.33 to 0.91), P = 0.02].ConclusionsTAVI patients with hepatic insufficiency may have negative impact both on short-term (in-hospital or 30-day) and 1–2-years mortality. For patients with hepatic insufficiency, TAVI could be a better option than SAVR.

Five-Year Survival of Transcatheter Aortic Valve Implantation in High-Risk Patients

Although transcatheter aortic valve implantation (TAVI) has become the standard treatment for severe aortic stenosis in high-risk patients in Australia, there is still limited data on long term survival. All patients undergoing TAVI at a single tertiary institution between September 2009 and December 2015 were included. The primary outcome was survival, by linkage of patients with the National Death Index of the Australian Institute of Health and Welfare. Post-procedure data and echocardiographic measurements were retrospectively analysed for all patients. A total of 186 patients were included. It was a high-risk patient population (mean EuroSCORE 31.5±20.5, mean age 83.0±8.2 years). Valve prostheses used were Edwards SAPIEN (ES) (Edwards, Irvine, CA, USA) in 16.1%, Edwards SAPIEN XT (ESXT) in 74.2%, and Medtronic CoreValve (MCV) (Medtronic, Minneapolis, MN, USA) in 9.7%. Median survival time for the entire cohort was 68.2 months (95% Confidence Interval [CI]; Lower Limit [LL] 58.0 months, Upper Limit [UL] not defined). The 2- and 5-year estimates of survival were 85% (LL 80%, UL 90%) and 56% (LL 48%, UL 66%), respectively. There was no statistically significant difference in median survival between the ES and ESXT valves, or implantation approach. Survival was greater in patients with creatinine <200 μmol/L compared to >200 μmol/L (68.8 months [LL 61.4, UL n/a] vs 48.0 months [LL 25.5, UL n/a]). Over the study period, there was a statistically significant trend in increasing mean transvalvular gradient (ES: 1.66 mmHg/yr, p=0.0058; ESXT: 2.50 mmHg/yr, p≤0.001) and maximum velocity (ESXT: 0.16 m/s/yr, p=0.004) and decreasing valve area (ESXT: -0.07 cm2/yr, p<0.001). There was substantial attrition of patient echocardiographic follow-up (number of echocardiograms followed up at 5 years=6, number at risk=41). This study has demonstrated acceptable survival in a high-risk cohort of patients undergoing TAVI, with comparable results to larger international experiences. There was a trend for worsening haemodynamics that needs to be monitored. Future studies need to examine patient quality of life and the performance of newer generation prostheses.

Understanding Repeat Hospitalizations in Intermediate- to High-Risk Aortic Stenosis Patients Following Transcatheter Aortic Valve Replacement

Understanding Repeat Hospitalizations in Intermediate- to High-Risk Aortic Stenosis Patients Following Transcatheter Aortic Valve Replacement

Pacemaker dependency after transcatheter aortic valve replacement compared to surgical aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) is a standard treatment indicated for severe aortic stenosis in high-risk patients. The objective of this study was to evaluate the incidence of pacemaker dependency after permanent pacemaker implantation (PPI) following TAVR or surgical aortic valve replacement (SAVR) and the risk of mortality at a tertiary center in Korea.In this retrospective study conducted at a single tertiary center, clinical outcomes related to pacemaker dependency were evaluated for patients implanted with pacemakers after TAVR from January 2012 to November 2018 and post-SAVR from January 2005 to May 2015. Investigators reviewed patients’ electrocardiograms and baseline rhythms as well as conduction abnormalities. Pacemaker dependency was defined as a ventricular pacing rate > 90% with an intrinsic rate of <40 bpm during interrogation.Of 511 patients who underwent TAVR for severe AS, 37(7.3%) underwent PPI after a median duration of 6 (3–7) days, whereas pacemakers were implanted after a median interval of 13 (8–28) days post-SAVR in 10 of 663 patients (P < .001). Pacemaker dependency was observed in 36 (97.3%) patients during 7 days immediately post-TAVR and in 25 (64.9%) patients between 8 and 180 days post-TAVR. Pacemaker dependency occurred after 180 days in 17 (50%) patients with TAVR and in 4 (44.4%) patients with SAVR. Twelve (41.4%) patients were pacemaker-dependent after 365 days post-TAVR.Pacemaker dependency did not differ at 6 months after TAVR vs SAVR. In patients undergoing post-TAVR PPI, 58.6% were not pacemaker-dependent at 1 year after the TAVR procedure.

Single-center experience of 105-minimalistc transfemoral transcatheter aortic valve replacement and its outcome

IntroductionTranscatheter aortic valve replacement (TAVR) increases worldwide, and indications expand from high-risk aortic stenosis patients to low-risk aortic stenosis. Studies have shown that minimalistic TAVR done under conscious sedation is safe and effective. We report single-operator, the single-center outcome of 105 minimalist transfemoral, conscious sedation TAVR patients, analyzed retrospectively. MethodsAll patients underwent TAVR in cardiac catheterization lab via percutaneous transfemoral, conscious sedation approach. A dedicated cardiac anesthetist team delivered the conscious sedation with a standard protocol described in the main text. The outcomes were analyzed as per VARC-2 criteria and compared with the latest low-risk TAVR trials. ResultsA total of 105 patients underwent transcatheter aortic valve replacement between July 2016 to February 2020. The mean age of the population was 73 years, and the mean STS score was 3.99 ± 2.59. All patients underwent a percutaneous transfemoral approach. Self-expanding valve was used in 40% of cases and balloon-expandable valve in 60% (Sapien3™ in 31% and MyVal™ in 29%) of cases. One patient required conversion to surgical aortic valve replacement. The success rate was 99 percent. The outcomes were: all-cause mortality: 0.9%, stroke rate 1.9%, New pacemaker rate 5.7%, 87.6% had no paravalvular leak. The mild and moderate paravalvular leak was seen in 2.8% and 1.9%, respectively. The mean gradient decreased from 47.5 mmHg to 9 mmHg. The average ICU stay was 26.4 h, and the average hospital stay was 5.4 days. Our outcomes are comparable with the latest published low-risk trial. ConclusionMinimalist, conscious sedation, transfemoral transcatheter aortic valve replacement when done following a standard protocol is safe and effective.

Stress Echocardiography in Aortic Stenosis

In apparently asymptomatic severe aortic stenosis (AS) group, stress echocardiography objectively identifies symptomatic, high-risk AS patients requiring early aortic valve replacement (AVR). The low-flow, low-gradient AS is well-characterized clinical entity with distinct diagnostic, management, and clinical outcome challenges. A comprehensive two-dimensional transthoracic echocardiography (2D echo) and Doppler and low-dose dobutamine stress echocardiography are of paramount importance for accurate diagnosis and timely decision of AVR. However, clinicians and imaging experts should be aware of the pitfalls and inaccuracies inherent in 2D echo/Doppler measurements and the effects of pathophysiological factors which impact the stroke volume and transvalvular gradient measurements. In appropriate clinical situations, clinicians should take additional help of cardiac computational tomography, cardiac magnetic resonance imaging, and biomarkers.

Stress echocardiography in aortic stenosis

In apparently asymptomatic severe aortic stenosis (AS) group, stress echocardiography objectively identifies symptomatic, high-risk AS patients requiring early aortic valve replacement (AVR). The low-flow, low-gradient AS is well-characterized clinical entity with distinct diagnostic, management, and clinical outcome challenges. A comprehensive two-dimensional transthoracic echocardiography (2D echo) and Doppler and low-dose dobutamine stress echocardiography are of paramount importance for accurate diagnosis and timely decision of AVR. However, clinicians and imaging experts should be aware of the pitfalls and inaccuracies inherent in 2D echo/Doppler measurements and the effects of pathophysiological factors which impact the stroke volume and transvalvular gradient measurements. In appropriate clinical situations, clinicians should take additional help of cardiac computational tomography, cardiac magnetic resonance imaging, and biomarkers.

Latent myopathy is more pronounced in patients with low flow versus normal flow aortic stenosis with normal left ventricular ejection fraction who are undergoing surgical aortic valve replacement: Multicenter study with a brief review of the literature.

Midwall fibrosis and low stroke volume are independent predictors of mortality in severe aortic stenosis (AS) with preserved LV ejection fraction (LVEF). The role of speckle tracking echocardiography (STE) to identify latent myopathy pre- and post- aortic valve replacement (AVR) in high risk AS patients with normal LVEF is limited. Demographic, 2D echocardiographic, and STE data were analyzed in patients with severe AS and preserved LVEF who underwent tissue AVR. Velocity vector imaging (VVI) was used to assess regional and global peak systolic longitudinal strain (GLS). Low flow (LF) was defined as an indexed LV stroke volume <35mL/m2 . Between December 2008 and May 2011, 37 patients (75±9years, 51% male) had both pre- and post-AVR echos within 6.6±6.5months (median= 4months; range=2.5-9.5) of surgery. Compared with pre-AVR, GLS (-6.9±4.9% vs -11.1±4.1%; P<.001) and strain rate (-0.72±0.3s-1 vs -0.87±0.3s-1 ; P=.01) improved post-AVR. Pre-AVR mid-segments showed a similar myopathy as the basal segments (-9.5±4.3% vs -9.0±4.2%;P=.3). The 16 (43%) LF patients in this study had lower pre- and post-AVR strain compared to NF patients (GLS Pre-AVR:LF vs NF: -5.1±4.1% vs -8.4±4.9% (P=.04) and GLS Post-AVR:LF vs NF: -9.2±3.7% vs -12.5±3.9% (P=.01)). However, there was no difference in absolute and %change improvement in GLS post-AVR (LF vs NF:∆ -4.2±3.5% vs ∆-4.1±5.3% (P=.90) and 193 ± 214% vs 143 ± 230% change (P=.5)). The lowest GLS was seen in LF/HG AS followed by LF/LG, NF/LG and NF/HG AS; P=.03. Latent myopathy is more pronounced in LF AS both pre- and post-AVR. Our study provides evidence of improvement in myopathy in LF AS despite a persistent worse myopathy compared to NF patients post-AVR.

Recent advances in understanding and managing aortic stenosis.

Over the last few years, treatment of severe symptomatic aortic stenosis in high-risk patients has drastically changed to adopt a less-invasive approach. Transcatheter aortic valve implantation (TAVI) has been developed as a very reproducible and safe procedure, as shown in many trials. When compared to surgery, TAVI has produced superior, or at least comparable, results, and thus a trend to broaden treatment indications to lower-risk patients has erupted as a natural consequence, even though there is a lack of long-term evidence. In this review, we summarize and underline aspects that still remain unanswered that are compulsory if we want to enhance our understanding of this disease.

Incidence and Predictors of Vascular Complications in Transcatheter Aortic Valve Implantation

Introduction: Transcatheter aortic valve implantation (TAVI) is superior to surgical aortic valve replacement for symptomatic severe aortic stenosis in high-risk patients. Documented rates of vascular complications (VC) and bleeding (BC) complications are low; however, few Australian studies have assessed incidence and predictors of VC and BC after TAVI. The primary objective of this study was to identify the incidence and predictors of VC in patients undergoing TAVI within this cohort.

Эндоваскулярное лечение больных с критическим аортальным стенозом: сoвременное состояние проблемы и перспективы

The article contains the review of current understanding of the etiology and pathogenesis of degenerative aortic stenosis, approaches to surgical treatment depending on various factors, e. g. severity of defect and comorbidity, description of endovascular techniques (balloon valvuloplasty and transcatheter aortic valve implantation), and features of the selection of patients for these procedures. The authors also present assessment of results of operations performed from 2011 to 2016 in the city hospital № 2 in Saint-Petersburg. They analyze data from 72 high-risk aortic stenosis patients aged 81±6 years treated with transcatheter aortic valve implantation. In 68 out of 72 patients (94.4 %) clinical improvement was achieved with reduction of dilation of left ventricular cavity, decrease of functional class of heart failure, and decrease of mean pressure gradient across the aortic valve. A conclusion is made that these results confirm advantages and perspectives of the use of endovascular methods of treatment in this complicated group of patients.

Implantation and 30-Day Follow-Up on All 4 Valve Sizes Within the Portico Transcatheter Aortic Bioprosthetic Family

ObjectivesThe aim of this study was to evaluate the short-term safety and performance of the full range of valve sizes offered within the Portico transcatheter aortic valve replacement system. BackgroundThe Portico transcatheter aortic heart valve is a fully resheathable, repositionable, and self-expanding bioprosthesis designed to achieve optimal valve position and hemodynamic performance and limit conduction disturbances. MethodsPatients (n = 222) with symptomatic (New York Heart Association functional class ≥II) severe aortic stenosis considered by a multidisciplinary heart team to be at high surgical risk were recruited between December 2011 and September 2015 in this prospective, nonrandomized, multicenter study. Patients were implanted with the full range of Portico heart valves (23, 25, 27, and 29 mm) using the transfemoral approach. The primary endpoint was all-cause mortality at 30 days. Secondary endpoints included valve performance, improvement in functional class, and procedural outcomes as defined by Valve Academic Research Consortium criteria. ResultsA total of 220 patients (mean age 83.0 ± 4.6 years, 74.3% women, mean Society of Thoracic Surgeons score 5.8%) had valves implanted. All resheathing and repositioning attempts (n = 72) were successful. At 30 days, all-cause mortality was 3.6%. Procedural outcomes included disabling (major) stroke (3.2%), major vascular complications (7.2%), and permanent pacemaker implantation (13.5%). Compared with baseline, 75.8% of patients improved by ≥1 New York Heart Association functional class at 30 days. The rate of moderate paravalvular leak was 5.7%, with no severe paravalvular leak reported. No differences in paravalvular leak incidence and severity were observed among valve sizes (p = 0.24). ConclusionsAcross all valve sizes, use of the repositionable Portico transcatheter aortic valve replacement system resulted in safe and effective treatment of aortic stenosis in high-risk patients.

Feasibility and applicability of static vascular outline roadmapping during transcatheter aortic valve implantation.

We investigated the application and feasibility of a novel software tool designed for the visualization of the aortic root during transcatheter aortic valve implantation (TAVI). The final positioning of the device prior deployment remains the most critical phase during TAVI. Philips "Vascular Outlining" prototype application was used during balloon expandable Edwards Lifesciences SapienXT valve deployment. It processes any angiographic sequences, extracting the static outline of vessels and projecting the two-dimensional vessel margins as a roadmap on live fluoroscopy. Preoperational planning, sizing and anatomical assessment of access routes were performed using computed tomography scans and the Philips "HeartNavigator" software. Fifteen high-risk aortic stenosis patients (mean age 82.0±6.6 years) underwent TAVI via transfemoral (N.=8), transapical (N.=4), and transaortic (N.=3) access routes. Mean logistic EuroSCOREs and STS-scores were 19.7±4.3% and 7.9±3.1%, respectively, mean aortic gradient was 66.3±18.3 mmHg. All valves were implanted successfully with none or trivial paravalvular regurgitation in 11 patients, mild in 3 patients, and moderate in 1 patient. TAVI was performed in all cases with only one aortic root contrast media injection during valve deployment. No major stroke or cardiovascular death occurred within 30 days. "Vascular Outlining"-guided implantation of the SapienXT valve is feasible. This new feature might increase the accuracy of valve placement and also may reduce the need for extra contrast media use during valve deployment. However, the lack of real-time motion compensation limits its wide application, as the overlay does not move together with respiratory and cardiac motion.

Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment.

Galectin-3 (Gal-3), a β-galactoside-binding lectin, has been implicated in myocardial fibrosis, development of left ventricular (LV) dysfunction and transition from compensated LV hypertrophy to overt heart failure (HF), being a novel prognostic marker in HF. Risk stratification is crucial for the choice of the optimal therapy in degenerative aortic stenosis (AS), affecting elderly subjects with coexistent diseases. Our aim was to assess correlates and prognostic value of circulating Gal-3 in real-world patients with degenerative AS referred for invasive treatment. Gal-3 levels were measured at admission in 80 consecutive patients with symptomatic degenerative AS (mean age: 79 ± 8 years; aortic valve area (AVA) index: 0.4 ± 0.1 cm2/m2). The therapeutic strategy was chosen following a dedicated multidisciplinary team-oriented approach, including surgical valve replacement (n = 11), transcatheter valve implantation (n = 19), balloon aortic valvuloplasty (BAV) (n = 25) and optimal medical therapy (n = 25). Besides routine echocardiographic indices, valvulo-arterial impedance (Zva), an index of global LV afterload, was computed. There were 22 deaths over a median follow-up of 523 days. Baseline Gal-3 correlated negatively with estimated glomerular filtration rate (eGFR) (r = −0.61, p < 0.001) and was unrelated to age, symptomatic status, AVA index, LV ejection fraction, LV mass index or Zva. For the study group as a whole, Gal-3 tended to predict mortality (Gal-3 >17.8 vs. Gal-3 <17.8 ng/mL; hazard ratio (HR): 2.03 (95% confidence interval, 0.88–4.69), p = 0.09), which was abolished upon adjustment for eGFR (HR: 1.70 (0.61–4.73), p = 0.3). However, in post-BAV patients multivariate-adjusted pre-procedural Gal-3 was associated with worse survival (HR: 7.41 (1.52–36.1), p = 0.01) regardless of eGFR. In conclusion, the inverse eGFR–Gal-3 relationship underlies a weak association between Gal-3 and adverse outcome in patients with degenerative AS referred for invasive therapy irrespective of type of treatment employed. In contrast, pre-procedural Gal-3 appears an independent mortality predictor in high-risk AS patients undergoing BAV.

TEMPORAL CHANGE IN MYOCARDIAL CONTRACTILITY AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT AND ITS RELATIONSHIP WITH QUALITY OF LIFE

Background: Myocardial contractility, measured as LV global longitudinal strain (LV-GLS), predicts clinical outcomes. Transcatheter Aortic Valve Replacement (TAVR), a treatment of severe aortic stenosis in high-risk patients, results in afterload reduction and change in myocardial contractility. We

INTRAOPERATIVE CHANGE IN MYOCARDIAL CONTRACTILITY WITH TRANSCATHETER AORTIC VALVE REPLACEMENT PREDICTS CARDIOVASCULAR OUTCOMES

Background: Transcatheter Aortic Valve Replacement (TAVR), a treatment of severe aortic stenosis in high-risk patients, results in afterload reduction and change in myocardial contractility. We aimed to determine the predictors of intraoperative change in myocardial contractility and its influence

TRANSCATHETER AORTIC VALVE REPLACEMENT IN END STAGE LIVER DISEASE

Background: Transcatheter aortic valve replacement (TAVR) has emerged as a therapeutic option to treat severe aortic stenosis in high-risk patients. Patients with cirrhosis and end-stage liver disease show high operative morbidity and mortality with cardiac surgery. The Society of Thoracic Surgeons