Aortic Valve Replacement In Patients Research Articles

Malnutrition Predicts Adverse Outcomes After Transcatheter Aortic Valve Replacement: ASystematic Review and Meta-Analysis.

Several studies have shown that malnutrition helps to predict the occurrence of adverse outcomes after transcatheter aortic valve replacement. However, there is still controversy and uncertainty regarding the prevalence and consequences of malnutrition. We performed a systematic review and meta-analysis to assess the relationship between malnutrition and poor postoperative outcomes in transcatheter aortic valve replacement. Observational studies were searched in PubMed, EMBASE, Cochrane Library, Web of Science, and MEDLINE regarding the relationship between malnutrition and adverse outcomes after transcatheter aortic valve replacement, with the primary end-point being all-cause mortality and secondary outcomes such as cardiovascular complications and readmission rates. This meta-analysis was registered in PROSPERO (number CRD42022310139). A total of 10 studies involving 5936 subjects were included in the systematic review and meta-analysis. The results showed that malnourished patients had an increased risk of all-cause mortality after transcatheter aortic valve replacement compared with non-malnourished patients (hazard ratios [HR] = 1.32, 95% CI [1.13, 1.53], P <.01). Subgroup analysis showed that in Asia, postoperative all-cause mortality was significantly higher in malnourished transcatheter aortic valve replacement patients than in non-malnourished transcatheter aortic valve replacement patients (P <.01), and in addition, sample size and follow-up time may have contributed to the large heterogeneity. Malnutrition increases the risk of all-cause mortality in such patients and may predict the occurrence of adverse postoperative outcomes.

Direct oral anticoagulant versus antiplatelet therapy following transcatheter aortic valve replacement in patients without prior or concurrent indication for anticoagulation: A meta-analysis of randomized studies.

The antithrombotic management following transcatheter aortic valve replacement (TAVR) in patients who do not have a concurrent indication for long-term anticoagulation therapy is an ongoing source of debate. We performed a systematic review and meta-analysis to compare direct oral anticoagulants (DOACs) versus antiplatelet therapy after TAVR in patients without a concomitant indication for chronic oral anticoagulation. PubMed, Embase, and Cochrane databases were searched. Only randomized controlled trialswere included. Risk ratios (RR) with p < 0.05 were considered statistically significant. Three studies were included, with 2922 patients who underwent TAVR, of whom 1463 (50.1%) received DOACs. Patients who received DOACs therapy had significantly higher all-cause mortality (RR: 1.68; 95% confidence intervals[CI]: 1.22-2.30; p = 0.001) and non-cardiovascular mortality (RR: 2.33; 95% CI: 1.13-4.80; p = 0.02). The incidence of major bleeding was not significantly different between the groups (5.3% vs. 3.8%; RR: 1.44; 95% CI: 0.90-2.32; p = 0.13). There was no difference between DOACs and antiplatelet therapy in terms of: ischemic stroke (RR: 1.28; 95% CI: 0.76-2.15; p = 0.35) and cardiovascular mortality (RR: 1.36; 95% CI: 0.92-2.03; p = 0.13). Lastly, the DOACs group had a significantly lower risk of valve thrombosis than the antiplatelet group (0.8% vs. 3.2%; RR: 0.27; 95% CI: 0.14-0.51; p < 0.0001). In this meta-analysis of randomized studies comparing DOACs to antiplatelet therapy after TAVR in patients without a concomitant indication for anticoagulation, DOACs were associated with a lower incidence of valve thrombosis and a higher rate of all-cause mortality, driven by an increase in noncardiac causes of death.

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis.

The effect of arterial stiffening on elevated pulsatile left ventricular afterload patients with aortic stenosis (AS) is pronounced beyond systemic hypertension. Circulatory afterload pulsatile efficiency (CAPE) is a marker of vascular function, defined as the ratio of steady state energy consumption (SEC) to maintain systemic circulation and pulsatile energy consumption (PEC). Twenty patients aged 80 ± 7 years were assessed at baseline and a median of 60 days post transcatheter aortic valve replacement (TAVR), with pulsatile vascular load calculated using simultaneous radial applanation tonometry derived aortic pressure and cardiac magnetic resonance phase-contrast imaging derived ascending aortic flow. Eight out of 20 patients had a reduction in PEC post TAVR, and the reduction of PEC correlated strongly with the number of days post TAVR (R = 0.62, P < 0.01). Patients assessed within the 100 days of TAVR had a rise in their PEC when compared to baseline (0.19 ± 0.09 vs 0.14 ± 0.08 W, P = 0.04). Baseline PEC correlated moderately with baseline SEC (R = 0.49, P = 0.03), and a high baseline PEC was predictive of post TAVR PEC reduction (R = 0.54, P =0.01). Overall, no significant differences were found between baseline and post TAVR for systolic aortic pressure (131 ± 20 vs 131 ± 20 mmHg), systemic vascular resistance (1894 ± 493 vs 2015 ± 519 dynes.s/cm5), aortic valve ejection time (337 ± 22 vs 324 ± 34 ms) or aortic characteristic impedance (120 ± 48 vs 107 ± 41 dynes.s/cm5). Improved flow profiles after TAVR likely unmask the true vascular properties by altering ventriculo-valvulo-arterial coupling, leading to downstream vascular remodelling secondary to flow conditioning, and results in eventual improvement of pulsatile afterload as reflected by our proposed index of CAPE.

Rifampin-warfarin interaction in a transcatheter aortic valve replacement patient with septic knee arthritis

Warfarin therapy is known to participate in numerous drug-drug interactions that may cause substantial fluctuations in anticoagulation status. Rifampin is a commonly used antibiotic that also possesses the capability to interact with a multitude of medications, including warfarin, due to its strong induction capabilities on the CYP450 system, including CYP2C9, CYP3A4, CYP1A2, and CYP2C19

Ten years' experience with the sutureless aortic valve replacement: incidence and predictors for survival and valve durability at follow-up.

Aortic valve replacement with a sutureless prosthesis [sutureless aortic valve replacement (Su-AVR)] is an option for patients with severe aortic valve stenosis. However, data regarding long-term outcomes and prosthesis durability are still lacking. All consecutive patients who successfully underwent Su-AVR with the Perceval valve in our centre between 2010 and 2020 were included in the analysis and followed prospectively with echocardiography. Risk factor analysis was performed to assess variables associated with worse survival and bioprosthetic valve failure. Study population consisted of 547 patients: the mean age was 76.4 (5.2) years, 51% were female and the mean logistic EuroSCORE was 13% (11). The median survival was 7.76 years [95% confidence interval (CI) = 6.9-8.6]. Risk factor analysis identified age [hazard ratio (HR) 1.06, 95% CI 1.03-1.11; P < 0.001), EuroSCORE II (HR 1.08, 1.02-1.13; P < 0.001), baseline dialysis (HR 2.14, 95% CI 1.4-4.4; P = 0.038) and postoperative acute kidney injury ≥2 (HR 8.97, 95% CI 4.58-17.6; P < 0.001) as factors significantly correlated with worse survival. The reported HRs for age are per 1 year and for EuroSCORE II is 1 percentage point. Structural valve deterioration (SVD) was observed in 23 patients, of whom 19 underwent reintervention (median freedom from SVD 10.3 years). In multivariable Cox analysis, age (HR 0.89, 95% CI 0.82-0.95; P < 0.001) was found to be a significant predictor of SVD. Overall, 1.8% was referred for prosthetic valve endocarditis (confirmed or suspected) during follow-up. One patient showed moderate non-SVD and none developed prosthetic valve thrombosis. The sutureless valve represents a reliable bioprosthesis for aortic valve replacement in patients with a 10-year life expectancy. Younger age at the time of implant is the only factor associated with the risk of long-term SVD.

Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

BackgroundPatients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.MethodsThe retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.ResultsWithin the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively.ConclusionsReduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention.Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

Bioprosthetic reoperative aortic valve replacement in patients under 50

A clinical decision report using: Chan V, Lam BK, Rubens FD, et al. Long-term evaluation of biological versus mechanical prosthesis use at reoperative aortic valve replacement. J Thorac Cardiovasc Surg. 2012;144(1):146-151. https://doi.org/10.1016/j.jtcvs.2011.08.041 for a patient considering reoperative aortic valve replacement.

The impact of extra-valvular cardiac damage on mid-term clinical outcome following transcatheter aortic valve replacement in patients with severe aortic stenosis.

To quantify extra-valvular cardiac damage associated with severe aortic valve stenosis (AS), a novel staging model was proposed. This study aimed to validate this model in patients undergoing transcatheter aortic valve replacement (TAVR) as well as to assess its prognostic impact. Based on echocardiographic findings, the following stages were applied: isolated AS (stage 0), left ventricular (LV) damage (stage 1), left atrial or mitral valve damage (stage 2), pulmonary hypertension or tricuspid regurgitation (stage 3), or right ventricular dysfunction (stage 4). The primary endpoint was 2-year all-cause mortality. The distribution across stages was 0.8% at stage 0, 7.5% at stage 1, 63.3% at stage 2, 18.3% at stage 3, and 10.1% at stage 4. All-cause mortality increased at all stages 1-4 (12.1%, 18.2%, 26.6%, and 28.2%; p = 0.023). In the multivariate model, the stage of cardiac damage, age, New York Heart Association (NYHA) class III/IV, peripheral artery disease, and previous pacemaker were independent predictors of the primary endpoint. Patients treated for severe AS show a high prevalence of extra-valvular cardiac damage. An increase in stage is associated with higher 2-year all-cause mortality. The application of this staging model may add value to current treatment algorithms.

Transcatheter versus surgical aortic valve replacement for stenotic bicuspid aortic valve: Systematic review and meta-analysis

ObjectivesBicuspid aortic valves have been excluded from randomized trials comparing transcatheter aortic valve replacement with surgical aortic valve replacement. We aimed to evaluate the outcomes of transcatheter aortic valve replacement versus surgical aortic valve replacement in patients with severe bicuspid aortic valve stenosis using a meta-analysis. MethodsMEDLINE and EMBASE were searched through March 2022 to identify observational studies comparing transcatheter aortic valve replacement and surgical aortic valve replacement for severe bicuspid aortic valve stenosis. Outcomes of interest were in-hospital outcomes, including all-cause mortality, stroke, vascular complication, permanent pacemaker implantation, acute kidney injury, blood transfusion, paravalvular leak, and all-cause mortality during follow-up. ResultsFour propensity score–matched studies and 54,047 patients (transcatheter aortic valve replacement, n = 3841; surgical aortic valve replacement, n = 50,206) yielding 3142 pairs using propensity score were included. Median follow-up periods were 21 to 24 months. There were no significant differences in in-hospital mortality (risk ratio, 0.69; 95% confidence interval, 0.40-1.20; P = .19) or stroke (risk ratio, 0.86; 95% confidence interval, 0.64-1.14; P = .29). Although transcatheter aortic valve replacement was associated with higher risks of permanent pacemaker implantation rate (risk ratio, 1.87; 95% confidence interval, 1.23-2.84; P = .0003), transcatheter aortic valve replacement was associated with lower risks of acute kidney injury (risk ratio, 0.58; 95% confidence interval, 0.38-0.88; P = .01) and transfusion (risk ratio, 0.25; 95% confidence interval, 0.21-0.29; P = .0001). There were no significant differences in in-hospital vascular complication, paravalvular leak, and all-cause mortality during follow-up. ConclusionsIn selected patients with severe bicuspid aortic valve stenosis, no significant differences in in-hospital mortality or stroke were observed between transcatheter aortic valve replacement and surgical aortic valve replacement. Further investigations with long-term follow-up and morphological features are warranted.

Coronary access after repeat transcatheter aortic valve replacement in patients of small body size: A simulation study

BackgroundCoronary artery access after repeat transcatheter aortic valve replacement (TAV-in-TAV) is reportedly more difficult because leaflet displacement of the first transcatheter heart valve (THV) impairs coronary cannulation; however, its effects in small patients are unknown. This study aimed to simulate coronary accessibility after TAV-in-TAV in patients of small body size. MethodsWe retrospectively analyzed computed tomography scans after initial THV implantation and classified patients by THV and coronary artery location, valve-to-aorta distance, and valve-to-coronary distance. Risks were compared between the SAPIEN and CoreValve/Evolut series, among THV generations, and between bicuspid and tricuspid aortic valves in the CoreValve/Evolut series. ResultsA total of 254 patients (SAPIEN series, n = 164; CoreValve/Evolut series, n = 90) were enrolled. The average body surface area of the patients was 1.44 m2. Patients were classified as “feasible” (26%), “theoretically feasible with low risk” (19.7%), “theoretically feasible with high risk” (8.7%), or “unfeasible” (45.8%). The “unfeasible” rate was significantly higher in the CoreValve/Evolut series than in the SAPIEN series (78.9% vs 26.2%; P < .001). A significantly higher “unfeasible” rate was identified in the current model of SAPIEN (SAPIEN, 8.3%; SAPIENXT, 1.8%; SAPIEN3, 48.2%; P < .001), but not in the CoreValve/Evolut series (CoreValve, 83.3%; Evolut R, 80.0%; Evolut PRO, 71.4%; P = .587). Patients with a bicuspid aortic valve had a lower “unfeasible” rate compared to those with a tricuspid aortic valve (60.0% vs 86.2%; P = .014). ConclusionsPatients of small body size may have a high probability of “unfeasible” coronary access after TAV-in-TAV, especially when treated with current high-frame devices, suggesting the need for careful strategic planning for initial THV implantation.

A 20-year journey in transcatheter aortic valve implantation: Evolution to current eminence.

Since the first groundbreaking procedure in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis (AS). Through striking developments in pertinent equipment and techniques, TAVI has now become the leading therapeutic strategy for aortic valve replacement in patients with severe symptomatic AS. The procedure streamlining from routine use of conscious sedation to a single arterial access approach, the newly adapted implantation techniques, and the introduction of novel technologies such as intravascular lithotripsy and the refinement of valve-bioprosthesis devices along with the accumulating experience have resulted in a dramatic reduction of complications and have improved associated outcomes that are now considered comparable or even superior to surgical aortic valve replacement (SAVR). These advances have opened the road to the use of TAVI in younger and lower-risk patients and up-to-date data from landmark studies have now established the outstanding efficacy and safety of TAVI in patients with low-surgical risk impelling the most recent ESC guidelines to propose TAVI, as the main therapeutic strategy for patients with AS aged 75 years or older. In this article, we aim to summarize the most recent advances and the current clinical aspects involving the use of TAVI, and we also attempt to highlight impending concerns that need to be further addressed.

Changes in aortic root dimensions after ascending aortic repair with concomitant aortic valve replacement

The issue of ascending aortic repair with concomitant aortic valve replacement in pa-tients with ascending aortic aneurysm (AscAA) and aortic valve stenosis is still debatable.Aim. To analyze the dimension changes of the preserved aortic root after simultaneous ascending aorta repair and aortic valve replacement.Material and methods. This retrospective study included 102 patients who, from December 2012 to May 2022, underwent simultaneous aortic valve replacement and ascending aorta repair with hemiarch replacement. Patients were divided into 2 following groups based on the aortic valve morphology: group 1 — patients with bicuspid aortic valve (BAV) and AscAA (n=75), group 2 — patients with tricuspid aortic valve (TAV) and AscAA (n=27). Depending on the presence of aortic root dilatation (maximum diameter (d) &gt;40 mm), each of the groups was additionally stratified into 2 more subgroups as follows: patients without aortic root dilatation (d≤40 mm) and patients with its dilatation (d&gt;40 mm). The dynamics of the aortic root diameter was assessed by computed tomography angiography.Results. The mean follow-up period for patients was 36,2±14,6 months. Survival rate in the BAV+AscAA and TAV+AscAA groups was 96% and 100%, respectively (p=0,380). Freedom from aortic root resurgery was 100% in both study groups. In patients with dilated and non-dilated aortic root of the BAV+AscAA group, an increase in aortic root dimension was noted at a rate of 0,65±0,51 mm/year and 0,32±0,27 mm/year, respectively. In patients of the TAV+AscAA group, a regression in dilated and non-dilated aortic root diameter was observed as follows: 0,93±0,48 mm/year and 0,56±0,43 mm/year, respectively.Conclusion. In patients with AscAA in combination with BAV stenosis after a singlestep surgical intervention, a weak negative dynamics of non-dilated and dilated aortic root is observed in the mid-term follow-up period. In patients with AscAA and TAV, there is involutive alterations of the aortic root dimension during 3-year follow-up.

Abstract 14021: A Meta Analysis for Clinical Outcomes of Transcatheter Aortic Valve Replacement in Patients With Bicuspid versus Tricuspid Aortic Valves Using Balloon Expandable versus Self Expanding Valves

Introduction: Over the past decade, several next generation transcatheter aortic valve replacement (TAVR) devices have been developed with the aim of improving patients’ outcomes. Bicuspid aortic valves (BAVs) are an emerging issue in TAVR practice. The goal of this study was to compare clinical outcomes of TAVR using balloon-expandable (BE) versus self-expanding (SE) transcatheter heart valves in patients with BAV vs tricuspid aortic valve (TAV). Methods: We searched PubMed, Cochrane and Embase databases systematically for relevant studies from inception to March 2022. The primary focus was 1-year all-cause mortality. Additional outcomes included short term (30-days) all-cause mortality, cardiovascular mortality, stroke, major/life threatening bleeding, permanent pacemaker (PPM) implantation and major vascular complications. Results: There were 28 studies with a total 346,033 patients who underwent TAVR, 17,835 of which had BAV stenosis. In the BE group, there was a statistically lower risk of mortality of TAVR in the BAV when compared to the TAV (OR 0.69 [95% CI 0.49-0.97]; p=0.03). In terms of short-term outcomes of BE group, the risks of all-cause mortality, stroke, PPM implantation, major bleeding, and major vascular complications were all similar between the two arms. In the SE group, there were not statistically significant in the clinical outcomes between patients in BAV and TAV. Conclusions: The use of balloon-expandable valves in TAVR was associated with a lower risk of 1-year mortality in patients with BAV compared to patients with TAV. These data support the need for a randomized trial to compare the balloon-expandable valves in BAV patients.

Abstract 14335: Vascular Complications and Outcomes Following Transcatheter Aortic Valve Replacement in Patients on Chronic Steroids Therapy. A Meta-Analysis

Introduction: Chronic steroids therapy was reportedly linked to increased vascular complications (VC) following invasive vascular procedures. However, its association with VC after transcatheter aortic valve replacement (TAVR) remained uncertain, with conflicting results being reported. We aimed to compare the rate of vascular complications and outcomes between patients with and without chronic steroid use after TAVR. Methods: We conducted a comprehensive literature search in PubMed, Embase and Cochrane databases for relevant studies. Endpoints were described according to Valve Academic Research Consortium-2 definitions and were assessed within 30 days of TAVR. Effect sizes were pooled using the DerSimonian and Laird random-effects model as risk ratio (RR) with 95% confidence intervals (CI). Results: 5 studies with 6136 patients undergoing TAVR (328 steroids, 5808 non-steroids) were included in the analysis. Patients on chronic steroids were younger (mean age 80.2 vs 82.3 years) and were more likely to be female (56% vs 54%). Patients on chronic steroids had a higher risk of major vascular complications (RR 2.32, 95% CI 1.73-3.11, p&lt;0.001), major bleeding (RR 1.61, 95% CI 1.27-2.05, p&lt;0.001) and aortic annulus rupture (RR 4.66, 95% CI 1.67-13.01, p&lt;0.001). There was no significant difference in terms of minor vascular complications (RR 1.43, 95% CI 1.00-2.04, p=0.05), in-hospital mortality (RR 1.86, 95% CI 0.74-4.70, p=0.19) and 30-day mortality (RR 1.14, 95% CI 0.53-2.46, p=0.74) between both groups. Conclusion: Chronic steroid therapy is associated with increased rate of major VCs, major bleeding and aortic annulus rupture following TAVR. Further randomized controlled trials were encouraged to confirm these findings.

Abstract 9809: Clinical Outcomes of Transcatheter Aortic Valve Replacement vs.surgical Aortic Valve Replacement in Patients With Durable Left Ventricular Assist Device

Introduction: Patients with left ventricular assist device (LVAD) often develop aortic insufficiency (AI) requiring an intervention on the aortic valve. We sought to analyze the outcomes of patients with a history of LVAD who underwent either transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). Methods: The Nationwide Readmission Database (NRD) was used to extract relevant patient information from January 1, 2016, to December 31, 2018. The NRD is a nationally representative sample of all-payer discharges from U.S. non-federal hospitals. The primary outcome of interest was in-hospital mortality. Secondary outcomes included length of stay, inpatient outcomes, costs, and 30-day all-cause readmissions. Complex samples multivariable logistic and linear regression models were used to determine the association of procedure type with outcomes. Results: Among 148 hospitalizations with a history of LVAD, 87 underwent TAVR, and 61 underwent SAVR. The inpatient mortality in SAVR group was numerically higher compared to the TAVR cohort, however, it did not reach statistical significance. The use of invasive mechanical ventilation, cardiogenic shock, bleeding, and vascular complications were higher in the SAVR cohort compared to the TAVR cohort. The mean length of stay (in days) and costs were higher in the SAVR cohort compared to the TAVR cohort. The 30-day all-cause readmission rate was numerically higher in the SAVR group, however, it was not statistically significant (Table 1). Conclusions: TAVR in patients with LVAD is a viable treatment option for AI and potentially leads to better inpatient mortality and inpatient outcomes compared to patients who undergo SAVR.

Abstract 15116: Left Ventricular Adaptation to Aortic Regurgitation in Adults With Repaired Coarctation of Aorta

Background: Aortic regurgitation (AR) can develop in adults with repaired coarctation of aorta (COA), but there are limited data about left ventricular (LV) remodeling and clinical outcomes in this population. The purpose of the study was to compare LV remodeling (LV mass index [LVMI], LV ejection fraction [LVEF], and septal E/e’) and onset of symptoms before aortic valve replacement (AVR), and LV reverse remodeling (%-change in LVMI, LVEF and E/e’) after AVR in patients with versus without repaired COA presenting with AR. Methods:: Asymptomatic adults with repaired COA presenting with moderate/severe AR (AR-COA group) were matched 1:2 to asymptomatic adults without COA and similar severity of AR (control group). Results: Although both groups (AR-COA n=52, and control n=104) had similar age, sex, body mass index, aortic valve gradient, and AR severity, the AR-COA group had higher LVMI (124±28 versus 102±25 g/m2, p&lt;0.001) and E/e’ (12.3±2.3 versus 9.5±2.1, p=0.02) but similar LVEF (63±9% versus 67±10%, p=0.4). COA diagnosis (adjusted HR 1.95, 95%CI 1.49-2.37, p&lt;0.001), older age, E/e’, and LV hypertrophy wereassociated with onset of symptoms. Of 89 patients (AR-COA n=41, and control n=48) with echocardiographic data at 1-year post-AVR, the AR-COA group had less regression of LVMI (-8% [95%CI -5 to -11] versus -17% [95%CI -15 to -21], p&lt;0.001) and E/e’ (-5% [95% CI -3 to -7] versus -16% [95% CI -13 to -19], p&lt;0.001). Conclusions: Patients with COA and AR had a more aggressive clinical course, and perhaps may require a different threshold for surgical intervention.

Abstract 15411: Life After the Valve, Analyzing Post-Procedural Anemia and Mortality in Transcatheter Aortic Valve Replacement Patients

Introduction: Transcatheter Aortic Valve Replacement (TAVR) has become the primary therapeutic option for many patients with severe aortic stenosis (AS). As a result, anemia is a prevalent co-morbidity amongst the TAVR population. Recent studies have demonstrated pre-procedural anemia is associated with increased long-term mortality in TAVR patients. However, the comparison of TAVR patients’ post-procedural anemia and its effect on mortality has not been fully investigated. Methods: Retrospective analysis of electronic medical records from 2018-2021 at the University of Illinois at Chicago and Jesse Brown VA Medical Center identified TAVR patients. Primary outcomes included all-cause mortality and significant bleeding at 6-months and 12-months post-TAVR. Results: We included 160 patients in the analysis. They were 122 males, 56.88% non-white, and an average age of 73.88. At 6-months, patients who experienced all-cause mortality had an average hemoglobin of 9.85 (g/dL) compared to an average hemoglobin of 11.31 in those patients that survived (p = 0.020). There was no significant difference in major bleeding events between the two groups (p = 0.974) as well as no significant difference in past-medical history, including hypertension, hyperlipidemia (HLD), diabetes mellitus, history of stroke and history of myocardial infarction. At 12-months, patients who experienced all-cause mortality had an average hemoglobin of 10.18 compared to an average hemoglobin of 11.36 in those patients that survived (p = 0.014). There was no significant difference in major bleeding events (p = 0.753) and no significant difference in past-medical history, except for hyperlipidemia. The prevalence of HLD was 59.09% in those that experienced all-cause mortality compared to 78.72% in those that did not (p = 0.045). Conclusions: Our results suggest that patients with lower hemoglobin levels after TAVR are at a greater risk of all-cause mortality compared to those with higher hemoglobin levels. These patients may benefit from closer follow-up after the procedure.

Imaging, Treatment Options, Patient Selection, and Outcome Considerations for Patients With Bicuspid Aortic Valve Disease.

Transcatheter aortic valve replacement has emerged as a safe and effective alternative to surgical aortic valve replacement for patients with severe symptomatic aortic stenosis across the spectrum of surgical risks based on a series of foundational randomized clinical trials. Of note, patients with bicuspid aortic valve (BAV) disease were excluded from all these pivotal randomized trials, leaving a significant knowledge gap because BAVs are commonly encountered in patients referred for aortic valve surgery or intervention. In this comprehensive review, we aim to provide heart teams with a detailed insight into how to approach patients with BAV disease, focusing on imaging and characterization of bicuspid valves, an overview of surgical approaches, and an understanding of the current data behind the role of transcatheter aortic valve replacement for patients with BAV disease.

Transcatheter aortic valve replacement in patients with aortic stenosis and reduced left ventricular ejection fraction – single-center experience

Transcatheter aortic valve replacement in patients with aortic stenosis and reduced left ventricular ejection fraction – single-center experience

Grading of Aortic Stenosis: Is it More Complicated in Women?

Aortic stenosis (AS) is the most common valvular heart disease and the main indication for valvular replacement in older women. Correct AS grading is mandatory for an adequate selection of patients for both surgical and transcatheter aortic valve replacement. Women and men have different AS severity grades at the same level of aortic valve calcification. Moreover, besides having smaller cardiac volumes, left ventricular outflow tract and aortic size, women have a specific pattern of left ventricular structural and functional remodelling in response to the AS-related chronic pressure overload. Here, the sex-specific cardiac changes in AS that make AS grading more challenging in women, with consequences for the management and outcome of this group of patients, are reviewed.