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Journal articles on the topic 'TAVR'

Author: Grafiati
Published: 4 June 2021
Last updated: 10 March 2023

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1

Cheng, Tsung O. "Is It TAVI or TAVR?" International Journal of Cardiology 175, no. 2 (August 2014): 222–23. http://dx.doi.org/10.1016/j.ijcard.2014.05.006.

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2

Thourani, Vinod H., J. James Edelman, and Christopher U. Meduri. "TAVR in TAVR." Journal of the American College of Cardiology 75, no. 16 (April 2020): 1894–96. http://dx.doi.org/10.1016/j.jacc.2020.03.017.

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3

Rogers, Toby, Jaffar M. Khan, Lowell F. Satler, Adam B. Greenbaum, and Robert J. Lederman. "TAVR-in-TAVR?" Journal of the American College of Cardiology 76, no. 8 (August 2020): 1003. http://dx.doi.org/10.1016/j.jacc.2020.05.083.

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4

Khan, Arshan, Muhammad Nadeem, Abhirami Shankar, Muhammad Haseeb ul Rasool, Muhammad Haseeb, Muhammad Ammar, and Abdul Wasay. "The Use of Antiplatelet and Anticoagulation After TAVR: A Brief Review of Important Literature." International Journal of Medical Science and Clinical Invention 11, no. 06 (June 4, 2022): 6134–40. http://dx.doi.org/10.18535/ijmsci/v9i06.02.

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Aortic stenosis is the most common valvular heart disease in the elderly patient population. Surgical aortic valve replacement (SAVR) has been the standard of practice for treating aortic stenosis for years. But recently in the past decade, the minimally invasive procedure Transcatheter aortic valve replacement/implantation (TAVR/TAVI) has been a revolutionary treatment modality for aortic stenosis patients, particularly those who are at high risk of surgery. The patients who undergo TAVR are at high risk for bleeding and thromboembolic events afterward. The use of antiplatelet and anticoagulation after TAVR is to decrease the risk of thromboembolic complications such as stroke, but it comes with the risk of bleeding associated with antiplatelet and antithrombotic. Current guidelines recommend the use of dual antiplatelet (DAPT) for 3 to 6-month after TAVR in the absence of an indication for oral anticoagulation followed by lifelong single antiplatelet therapy (SAPT). However, the use of dual antiplatelet is associated with an increased risk of bleeding without significant ischemic benefits. Lifelong oral anticoagulation is recommended for patients who have other indications for anticoagulation. These treatment guidelines are driven by expert opinion, given the lack of large randomized control trials (RCT). In this review, we aim to discuss the need for antithrombotic and antiplatelets after TAVR and review important literature about current practice and expert recommendations about antiplatelet and anticoagulation after TAVR.
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5

Bernardi, Fernando Luiz de Melo, and Henrique Barbosa Ribeiro. "TAVR." JACC: Cardiovascular Interventions 12, no. 8 (April 2019): 778–80. http://dx.doi.org/10.1016/j.jcin.2019.02.048.

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6

Guedeney, Paul, and Jean-Philippe Collet. "TAVR." JACC: Cardiovascular Interventions 13, no. 22 (November 2020): 2667–69. http://dx.doi.org/10.1016/j.jcin.2020.09.025.

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7

Singh, Satinder P., Oluseun Alli, Spencer Melby, Massoud Lessar, Mark Sasse, Julian Booker, and James Davies. "TAVR." Journal of Thoracic Imaging 30, no. 6 (November 2015): 359–77. http://dx.doi.org/10.1097/rti.0000000000000175.

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8

King, Spencer B. "TAVR." JACC: Cardiovascular Interventions 9, no. 21 (November 2016): 2264–65. http://dx.doi.org/10.1016/j.jcin.2016.09.046.

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9

Carabello, Blase A. "TAVR." JACC: Cardiovascular Interventions 9, no. 24 (December 2016): 2555–56. http://dx.doi.org/10.1016/j.jcin.2016.10.015.

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10

Conti, C. Richard. "To TAVR or Not to TAVR." Cardiovascular Innovations and Applications 2, no. 3 (May 1, 2017): 403–5. http://dx.doi.org/10.15212/cvia.2016.0053.

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11

Tarantini, Giuseppe, and Luca Nai Fovino. "Coronary Access and TAVR-in-TAVR." JACC: Cardiovascular Interventions 13, no. 21 (November 2020): 2539–41. http://dx.doi.org/10.1016/j.jcin.2020.06.065.

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12

Waksman, Ron. "From TAVI to TAVR: transforming imagination into reality." Cardiovascular Revascularization Medicine 12, no. 6 (November 2011): 343–44. http://dx.doi.org/10.1016/j.carrev.2011.10.001.

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13

Sohal, Sumit, Harsh Mehta, Krishna Kurpad, Sheetal Vasundara Mathai, Rajiv Tayal, Gautam K. Visveswaran, Najam Wasty, Sergio Waxman, and Marc Cohen. "Declining Trend of Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Aortic Stenosis." Journal of Interventional Cardiology 2022 (September 19, 2022): 1–6. http://dx.doi.org/10.1155/2022/5688026.

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Introduction. The last decade has witnessed major evolution and shifts in the use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS). Included among the shifts has been the advent of alternative access sites for TAVR. Consequently, transapical access (TA) has become significantly less common. This study analyzes in detail the trend of TA access for TAVR over the course of 7 years. Methods. The national inpatient sample database was reviewed from 2011–2017 and patients with AS were identified by using validated ICD 9-CM and ICD 10-CM codes. Patients who underwent TAVR through TA access were classified as TA-TAVR, and any procedure other than TA access was classified as non-TA-TAVR. We compared the yearly trends of TA-TAVR to those of non-TA-TAVR as the primary outcome. Results. A total of 3,693,231 patients were identified with a diagnosis of AS. 129,821 patients underwent TAVR, of which 10,158 (7.8%) underwent TA-TAVR and 119,663 (92.2%) underwent non-TA-TAVR. After peaking in 2013 at 27.7%, the volume of TA-TAVR declined to 1.92% in 2017 ( p < 0.0001 ). Non-TA-TAVR started in 2013 at 72.2% and consistently increased to 98.1% in 2017. In-patient mortality decreased from a peak of 5.53% in 2014 to 3.18 in 2017 ( p = 0.6 ) in the TA-TAVR group and from a peak of 4.51% in 2013 to 1.24% in 2017 ( p = 0.0001 ) in the non-TA-TAVR group. Conclusion. This study highlights a steady decline in TA access for TAVR, higher inpatient mortality, increased length of stay, and higher costs compared to non-TA-TAVR.
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14

Aguado, Brian A., Katherine B. Schuetze, Joseph C. Grim, Cierra J. Walker, Anne C. Cox, Tova L. Ceccato, Aik-Choon Tan, et al. "Transcatheter aortic valve replacements alter circulating serum factors to mediate myofibroblast deactivation." Science Translational Medicine 11, no. 509 (September 11, 2019): eaav3233. http://dx.doi.org/10.1126/scitranslmed.aav3233.

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The transcatheter aortic valve replacement (TAVR) procedure has emerged as a minimally invasive treatment for patients with aortic valve stenosis (AVS). However, alterations in serum factor composition and biological activity after TAVR remain unknown. Here, we quantified the systemic inflammatory effects of the TAVR procedure and hypothesized that alterations in serum factor composition would modulate valve and cardiac fibrosis. Serum samples were obtained from patients with AVS immediately before their TAVR procedure (pre-TAVR) and about 1 month afterward (post-TAVR). Aptamer-based proteomic profiling revealed alterations in post-TAVR serum composition, and ontological analysis identified inflammatory macrophage factors implicated in myofibroblast activation and deactivation. Hydrogel biomaterials used as valve matrix mimics demonstrated that post-TAVR serum reduced myofibroblast activation of valvular interstitial cells relative to pre-TAVR serum from the same patient. Transcriptomics and curated network analysis revealed a shift in myofibroblast phenotype from pre-TAVR to post-TAVR and identified p38 MAPK signaling as one pathway involved in pre-TAVR–mediated myofibroblast activation. Post-TAVR serum deactivated valve and cardiac myofibroblasts initially exposed to pre-TAVR serum to a quiescent fibroblast phenotype. Our in vitro deactivation data correlated with patient disease severity measured via echocardiography and multimorbidity scores, and correlations were dependent on hydrogel stiffness. Sex differences in cellular responses to male and female sera were also observed and may corroborate clinical observations regarding sex-specific TAVR outcomes. Together, alterations in serum composition after TAVR may lead to an antifibrotic fibroblast phenotype, which suggests earlier interventions may be beneficial for patients with advanced AVS to prevent further disease progression.
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15

Zhou, Silvia L. "Prof. Arie Pieter Kapptein: the European TAVR/TAVI experience." Cardiovascular Diagnosis and Therapy 7, no. 1 (February 2017): 106–7. http://dx.doi.org/10.21037/cdt.2016.08.05.

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16

Sousa, Marlilia Moura Coelho, Israel Nunes Bezerra, Fábio Dias Nogueira, Leiz Maria Costa Veras, and Daniela Machado Bezerra. "O manejo pós operatório do implante do valvar aórtico percutâneo com uso de anticoagulantes e antiagregantes plaquetários: Uma revisão de literatura." Research, Society and Development 10, no. 6 (June 10, 2021): e58410615631. http://dx.doi.org/10.33448/rsd-v10i6.15631.

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Introdução: Um dos principais tratamentos da estenose aórtica pode ser feito através de um procedimento cirúrgico, de “peito aberto”, a substituição cirúrgica de valva aórtica (SAVR). Contudo, pacientes classificados como alto risco e/ou com sintomática grave são impossibilitados de realizá-la, diminuindo a sua sobrevida. Devido a isso, surgiram alternativas minimamente invasivas tal como o implante de válvula aórtica transcateter (TAVI). Um dos manejos do pós operatório desse paciente são com terapia de anticoagulantes orais. Objetivo: Conhecer os principais anticoagulantes utilizados no pós operatório da TAVR. Metodologia: Trata-se de estudo descritivo, do tipo revisão de literatura, através das seguintes bases de dados: Scielo, Pubmed e Science Direct. Resultados: Os artigos buscaram esclarecer a fisiopatologia da estenose aórtica, bem como o seu diagnóstico e tratamento. Estes artigos permitiram identificar o mecanismo de ação dos anticoagulantes utilizados no pós-operatório da TAVR. Conclusão: A síntese do conhecimento acerca do manejo da terapia dos anticoagulantes pós operatório da TAVR poderá subsidiar ações dos profissionais médicos a fim de evitar acontecimentos não fisiológicos.
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17

Khan, Jaffar M., Christopher G. Bruce, Vasilis C. Babaliaros, Adam B. Greenbaum, Toby Rogers, and Robert J. Lederman. "TAVR Roulette." JACC: Cardiovascular Interventions 13, no. 6 (March 2020): 787–89. http://dx.doi.org/10.1016/j.jcin.2019.10.010.

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18

Grube, Eberhard, and Jan-Malte Sinning. "Simplify TAVR?" JACC: Cardiovascular Interventions 13, no. 5 (March 2020): 603–5. http://dx.doi.org/10.1016/j.jcin.2020.01.213.

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19

De Backer, Ole, and Lars Søndergaard. "Redo-TAVR." JACC: Cardiovascular Interventions 13, no. 22 (November 2020): 2628–30. http://dx.doi.org/10.1016/j.jcin.2020.10.005.

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20

Mohammadi, Siamak, Josep Rodés-Cabau, and Dimitri Kalavrouziotis. "TAVR Access." Journal of the American College of Cardiology 74, no. 22 (December 2019): 2740–42. http://dx.doi.org/10.1016/j.jacc.2019.09.055.

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21

Chauhan, Siddharth, Simbo Chiadika, Tariq Dayah, Sam Chitsaz, and Prakash Balan. "Massive TAVR." JACC: Case Reports 2, no. 5 (May 2020): 711–15. http://dx.doi.org/10.1016/j.jaccas.2020.03.026.

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22

Carroll, John D. "TAVR Prognosis, Aging, and the Second TAVR Tsunami." Journal of the American College of Cardiology 68, no. 15 (October 2016): 1648–50. http://dx.doi.org/10.1016/j.jacc.2016.08.005.

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23

Tang, Gilbert H. L., Syed Zaid, Eisha Gupta, Hasan Ahmad, Asaad Khan, Jason C. Kovacic, Steven L. Lansman, George D. Dangas, Samin K. Sharma, and Annapoorna Kini. "Feasibility of Repeat TAVR After SAPIEN 3 TAVR." JACC: Cardiovascular Interventions 12, no. 13 (July 2019): 1290–92. http://dx.doi.org/10.1016/j.jcin.2019.02.020.

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24

Zoltowska, Dominika M., Yashwant Agrawal, Nilesh Patel, Nishtha Sareen, Jagadeesh K. Kalavakunta, Vishal Gupta, and Abdul Halabi. "Association Between Pulmonary Hypertension and Transcatheter Aortic Valve Replacement: Analysis of a Nationwide Inpatient Sample Database." Reviews on Recent Clinical Trials 14, no. 1 (January 30, 2019): 56–60. http://dx.doi.org/10.2174/1574887113666181120113034.

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Introduction: This study was done to review the association of pulmonary hypertension (PH) with Transcatheter Aortic Valve Replacement (TAVR) procedures done in the US for years 2010 to 2012. </P><P> Methods: We used Nationwide Inpatient Sample (NIS) data to extract data for patients who were hospitalized with a primary/secondary diagnosis of TAVR as specified by International Classification of Disease (ICD-9) codes 35.05 and 35.06. PH was identified with ICD-9 codes 416.0 and 416.8. Logistic regression models were used to analyze the association between PH and clinical outcomes of TAVR. Results: A total of 8,824 weighted discharges were identified with a primary/secondary diagnosis of TAVR, of which 1,976 (22.4%) also had PH. Mean age of patients undergoing TAVR with and without PH was 81.4 and 81.1 years, respectively. More females had a diagnosis of PH with TAVR when compared to males, (56.9% vs. 43.1). When controlling for demographics, diabetes and hypertension; the association between PH and TAVR was statistically significant (p<.0001). Estimated odds of TAVR with PH was 5.46 (95% CI: 4.63, 6.41) times greater than for TAVR without PH. Similarly, the estimated odds for a length of stay greater than 1 week for TAVR with PH was 1.43 (95% CI: 1.12, 1.82; p=.0034) times greater than odds for TAVR without PH. PH was not statistically significant for in-hospital mortality in patients receiving TAVR (p=0.7067). Conclusion: This study suggests that underlying PH does not influence the immediate mortality of patients underlying TAVR. Further studies are needed to delve into the bearing of PH on TAVR.
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25

Huang, Hans, Christopher P. Kovach, Sean Bell, Mark Reisman, Gabriel Aldea, James M. McCabe, Danny Dvir, and Creighton Don. "Outcomes of Emergency Transcatheter Aortic Valve Replacement." Journal of Interventional Cardiology 2019 (November 3, 2019): 1–7. http://dx.doi.org/10.1155/2019/7598581.

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Objective. To identify outcomes of patients undergoing emergency transcatheter aortic valve replacement (TAVR) and determine predictors of in-hospital mortality. Background. Emergency TAVR has emerged as a viable treatment strategy for patients with decompensated severe aortic stenosis and/or regurgitation; however, data on patients undergoing emergency TAVR are limited. Methods. All emergency TAVR procedures were identified from a single tertiary academic center between January 2015 and August 2018. Results. 31 patients underwent emergency TAVR due to cardiogenic shock (26 patients), electrical instability with incessant ventricular tachycardia (2 patients), severe refractory angina (2 patients), and decompensated heart failure with hypoxemic respiratory failure requiring mechanical ventilation (1 patient). Mechanical circulatory support (MCS) was used in 16 (51.6%). MCS initiation occurred immediately prior to TAVR in 10 patients and placed post-TAVR in 6 patients. 6 patients died before hospital discharge (in-hospital mortality 19.4%). 1-year and 2-year survival rates were 61.0% and 55.9%, respectively. Univariate predictors of in-hospital mortality were preprocedural pulmonary artery pulsatility index (PAPi) ≤1.8 (66.7% vs. 20.0%, p=0.01), intraprocedural cardiopulmonary resuscitation (CPR) (83.3% vs 4.0%, p≤0.001), acute kidney injury post-TAVR (80.0% vs. 4.2%, p≤0.001), initiation of dialysis post-TAVR (60.0% vs. 4.2%, p≤0.001), and MCS initiation post-TAVR (50.0% vs. 12.0%, p=0.03). MCS initiation before TAVR was associated with improved survival compared with post-TAVR initiation. Conclusion. Emergency TAVR in extreme risk patients with acute decompensated heart failure or cardiogenic shock secondary to severe aortic valve disease is associated with high in-hospital mortality rates. Careful patient selection taking into account right heart function, assessed by PAPi, and early utilization of MCS may improve survival following emergency TAVR.
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26

Lee, Hsiu-An, I.-Li Su, Shao-Wei Chen, Victor Chien-Chia Wu, Dong-Yi Chen, Pao-Hsien Chu, An-Hsun Chou, Yu-Ting Cheng, Pyng-Jing Lin, and Feng-Chun Tsai. "Direct aortic route versus transaxillary route for transcatheter aortic valve replacement: a systematic review and meta-analysis." PeerJ 8 (May 12, 2020): e9102. http://dx.doi.org/10.7717/peerj.9102.

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Background The transfemoral route is contraindicated in nearly 10% of transcatheter aortic valve replacement (TAVR) candidates because of unsuitable iliofemoral vessels. Transaxillary (TAx) and direct aortic (DAo) routes are the principal nonfemoral TAVR routes; however, few studies have compared their outcomes. Methods We performed a systematic review and meta-analysis to compare the rates of mortality, stroke, and other adverse events of TAx and DAo TAVR. The study was prospectively registered with PROSPERO (registration number: CRD42017069788). We searched Medline, PubMed, Embase, and Cochrane databases for studies reporting the outcomes of DAo or TAx TAVR in at least 10 patients. Studies that did not use the Valve Academic Research Consortium definitions were excluded. We included studies that did not directly compare the two approaches and then pooled rates of events from the included studies for comparison. Results In total, 31 studies were included in the quantitative meta-analysis, with 2,883 and 2,172 patients in the DAo and TAx TAVR groups, respectively. Compared with TAx TAVR, DAo TAVR had a lower Society of Thoracic Surgery (STS) score, shorter fluoroscopic time, and less contrast volume use. The 30-day mortality rates were significantly higher in the DAo TAVR group (9.6%, 95% confidence interval (CI) = [8.4–10.9]) than in the TAx TAVR group (5.7%, 95% CI = [4.8–6.8]; P for heterogeneity <0.001). DAo TAVR was associated with a significantly lower risk of stroke in the overall study population (2.6% vs. 5.8%, P for heterogeneity <0.001) and in the subgroup of studies with a mean STS score of ≥8 (1.6% vs. 6.2%, P for heterogeneity = 0.005). DAo TAVR was also associated with lower risks of permanent pacemaker implantation (12.3% vs. 20.1%, P for heterogeneity = 0.009) and valve malposition (2.0% vs. 10.2%, P for heterogeneity = 0.023) than was TAx TAVR. Conclusions DAo TAVR increased 30-day mortality rate compared with TAx TAVR; by contrast, TAx TAVR increased postoperative stroke, permanent pacemaker implantation, and valve malposition risks compared with DAo TAVR.
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27

Burke, Gordon M., Bruna Araujo Silva, Alexandre A. Marum, Alexandre L. Bortolotto, Bruce D. Nearing, Michael J. Chen, Sarah Fostello, Jeffrey J. Popma, Richard L. Verrier, and James D. Chang. "Speckle tracking strain and ECG heterogeneity correlate in transcatheter aortic valve replacement-induced left bundle branch blocks and right ventricular paced rhythms." Open Heart 8, no. 2 (October 2021): e001542. http://dx.doi.org/10.1136/openhrt-2020-001542.

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ObjectiveTranscatheter aortic valve replacement (TAVR) complications include left bundle branch block (LBBB) and right ventricular paced rhythm (RVP). We hypothesised that changes in electrocardiographic heterogeneity would correlate better with speckle tracking strain measures than with left ventricular ejection fraction (LVEF) on transthoracic echocardiogram (TTE) among patients with TAVR-induced conduction abnormalities.MethodsWe reviewed medical records of 446 consecutive patients who underwent TAVR at our institution. Of the 238 patients with 12-lead electrocardiograms (ECGs) that met our inclusion criteria, 58 had pre-TAVR and post-TAVR TTEs adequate for strain assessment. We compared patients who did not have an LBBB or RVP pre-TAVR and post-TAVR (controls, n=11) with patients who developed LBBBs (n=11) and who required RVPs (n=10) post-TAVR. In our study population (n=32, 41% female, mean age 85.8 years), we evaluated QRS complex duration, R-wave heterogeneity (RWH), T-wave heterogeneity (TWH), LVEF, global longitudinal strain (GLS) and mechanical dispersion (MD).ResultsTAVR-induced changes on ECG did not correlate with LVEF. TAVR-induced changes in MD and QRS complex duration correlated among all patients (r=0.4, p=0.04). GLS and RWH correlated among RVP patients (r=0.7, p=0.00003). MD and TWH correlated among LBBB patients (r=0.7, p=0.00004).ConclusionsIn this convenience sample of patients with TAVR-induced conduction abnormalities, RWH and TWH correlated with strain measures but not with LVEF. Strain measures, RWH and TWH may offer additional insights for pre-TAVR evaluation and post-TAVR clinical management.
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Burke, Gordon M., Bruna Araujo Silva, Alexandre A. Marum, Alexandre L. Bortolotto, Bruce D. Nearing, Michael J. Chen, Sarah Fostello, Jeffrey J. Popma, Richard L. Verrier, and James D. Chang. "Speckle tracking strain and ECG heterogeneity correlate in transcatheter aortic valve replacement-induced left bundle branch blocks and right ventricular paced rhythms." Open Heart 8, no. 2 (October 2021): e001542. http://dx.doi.org/10.1136/openhrt-2020-001542.

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ObjectiveTranscatheter aortic valve replacement (TAVR) complications include left bundle branch block (LBBB) and right ventricular paced rhythm (RVP). We hypothesised that changes in electrocardiographic heterogeneity would correlate better with speckle tracking strain measures than with left ventricular ejection fraction (LVEF) on transthoracic echocardiogram (TTE) among patients with TAVR-induced conduction abnormalities.MethodsWe reviewed medical records of 446 consecutive patients who underwent TAVR at our institution. Of the 238 patients with 12-lead electrocardiograms (ECGs) that met our inclusion criteria, 58 had pre-TAVR and post-TAVR TTEs adequate for strain assessment. We compared patients who did not have an LBBB or RVP pre-TAVR and post-TAVR (controls, n=11) with patients who developed LBBBs (n=11) and who required RVPs (n=10) post-TAVR. In our study population (n=32, 41% female, mean age 85.8 years), we evaluated QRS complex duration, R-wave heterogeneity (RWH), T-wave heterogeneity (TWH), LVEF, global longitudinal strain (GLS) and mechanical dispersion (MD).ResultsTAVR-induced changes on ECG did not correlate with LVEF. TAVR-induced changes in MD and QRS complex duration correlated among all patients (r=0.4, p=0.04). GLS and RWH correlated among RVP patients (r=0.7, p=0.00003). MD and TWH correlated among LBBB patients (r=0.7, p=0.00004).ConclusionsIn this convenience sample of patients with TAVR-induced conduction abnormalities, RWH and TWH correlated with strain measures but not with LVEF. Strain measures, RWH and TWH may offer additional insights for pre-TAVR evaluation and post-TAVR clinical management.
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29

Shnayien, Seyd, Keno Kyrill Bressem, Nick Lasse Beetz, Patrick Asbach, Bernd Hamm, and Stefan Markus Niehues. "Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution’s Experience." RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren 192, no. 12 (April 16, 2020): 1174–82. http://dx.doi.org/10.1055/a-1150-7646.

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Purpose To retrospectively investigate the effectiveness of a novel 3-phase protocol for computed tomography (CT) before transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) in terms of radiation dose and image quality. Materials and Methods A total of 107 nonrandomized patients (81 ± 7.4 years) scheduled for TAVI/TAVR underwent preprocedural CT on an 80-row CT scanner. 55 patients underwent a combined ECG-synchronized spiral scan of the chest and non-ECG-synchronized spiral scan of the abdomen/pelvis as recommended by the Society of Cardiovascular Computed Tomography (SCCT). 52 patients underwent an updated 3-phase variable helical pitch (vHP3) protocol combining a non-ECG-synchronized spiral scan of the upper thoracic aperture, followed by a prospective ECG-synchronized spiral scan of the heart, and a non-ECG-synchronized abdominal/pelvic spiral scan. The radiation dose was determined from an automatically generated protocol based on the CT dose index (CTDI). Objective image quality in terms of vessel attenuation and image noise was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated using a 4-point scale and compared for interrater agreement using Cohen’s weighted kappa coefficient (κw). All data were compared and statistically analyzed. Results Use of the novel 3-phase vHP3 protocol reduced the dose-length product (DLP) from 1256.58 ± 619.05 mGy*cm to 790.90 ± 238.15 mGy*cm, reducing the effective dose (E) from 21.36 ± 10.52 mSv to 13.44 ± 4.05 mSv and size-specific dose estimates (SSDE) from 20.85 ± 7.29 mGy to 13.84 ± 2.94 mGy (p < 0.001). There were no significant differences in objective and subjective image quality between the two protocols and between the two readers. Conclusion The novel 3-phase vHP3 protocol significantly reduces the radiation dose of preprocedural TAVI/TAVR CT without a loss of image quality. Key Points: Citation Format
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30

Marbach, Jeffrey A., Joshua Feder, Altyyeb Yousef, F. Daniel Ramirez, Trevor Simard, Pietro DiSanto, Juan J. Russo, et al. "Predicting Acute Kidney Injury following Transcatheter Aortic Valve Replacement." Clinical & Investigative Medicine 40, no. 6 (December 17, 2017): 243. http://dx.doi.org/10.25011/cim.v40i6.29125.

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Purpose: Acute kidney injury occurs in up to a quarter of patients following transcatheter aortic valve replacement (TAVR) and has been associated with increased short and long-term mortality rates. A variety of patient characteristics predictive of post-TAVR acute kidney injury (AKI) have been identified, however discrepancies among studies exist almost uniformly. We investigated the hypothesis that the change in glomerular filtration rate (ΔGFR) in response to contrast administered during pre-TAVR coronary angiography is predictive of ΔGFR post-TAVR. Methods: The study comprised 195 patients who underwent TAVR at a single center between August 2008 and June 2015 and were prospectively included in the CAPITAL TAVR registry. Multiple linear regression analysis was conducted to estimate the effect of independent variables on the change in renal function post-TAVR. Results: There was no relationship identified between the ΔGFR post-angiogram and the ΔGFR post-TAVR (r=0.043, P=0.582). Multiple linear regression analysis revealed that a significant amount of the change in renal function post-TAVR can be explained by the patient’s baseline creatinine (beta coefficient, -0.310, P
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Alzu’bi, Hossam, Anan Abu Rmilah, Ikram-UI Haq, Babikir Kheiri, Ahmad Al-abdouh, Bashar Hasan, Omar Elsekaily, et al. "Effect of TAVR Approach and Other Baseline Factors on the Incidence of Acute Kidney Injury: A Systematic Review and Meta-Analysis." Journal of Interventional Cardiology 2022 (October 27, 2022): 1–9. http://dx.doi.org/10.1155/2022/3380605.

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Background. Acute kidney injury (AKI) is a well-known complication following a transcatheter aortic valve replacement (TAVR) and is associated with higher morbidity and mortality. Objective. We aim to compare the risk of developing AKI after transfemoral (TF), transapical (TA), and transaortic (TAo) approaches following TAVR. Methods. We searched Medline and EMBASE databases from January 2009 to January 2021. We included studies that evaluated the risk of AKI based on different TAVR approaches. After extracting each study’s data, we calculated the risk ratio and 95% confidence intervals using RevMan software 5.4. Publication bias was assessed by the forest plot. Results. Thirty-six (36) studies, consisting of 70,406 patients undergoing TAVR were included. Thirty-five studies compared TF to TA, and only seven investigations compared TF to TAo. AKI was documented in 4,857 out of 50,395 (9.6%) patients that underwent TF TAVR compared to 3,155 out of 19,721 (16%) patients who underwent TA-TAVR, with a risk ratio of 0.49 (95% CI, 0.36–0.66; p < 0.00001 ). Likewise, 273 patients developed AKI out of the 1,840 patients (14.8%) that underwent TF-TAVR in contrast to 67 patients out of the 421 patients (15.9%) that underwent TAo-TAVR, with a risk ratio of 0.51 (95% CI, 0.27–0.98; p = 0.04). There was no significant risk when we compared TA to TAo approaches, with a risk ratio of 0.89 (95% CI, 0.29–2.75; p = 0.84). Conclusion. The risk of post-TAVR AKI is significantly lower in patients who underwent TF-TAVR than those who underwent TA-TAVR or TAo-TAVR.
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Mauri, Victor, Thomas Frohn, Florian Deuschl, Kawa Mohemed, Kathrin Kuhr, Andreas Reimann, Maria Isabel Körber, et al. "Impact of device landing zone calcification patterns on paravalvular regurgitation after transcatheter aortic valve replacement with different next-generation devices." Open Heart 7, no. 1 (May 2020): e001164. http://dx.doi.org/10.1136/openhrt-2019-001164.

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ObjectiveResidual paravalvular regurgitation (PVR) has been associated to adverse outcomes after transcatheter aortic valve replacement (TAVR). This study sought to evaluate the impact of device landing zone (DLZ) calcification on residual PVR after TAVR with different next-generation transcatheter heart valves.Methods642 patients underwent TAVR with a SAPIEN 3 (S3; n=292), ACURATE neo (NEO; n=166), Evolut R (ER; n=132) or Lotus (n=52). Extent, location and asymmetry of DLZ calcification were assessed from contrast-enhanced CT imaging and correlated to PVR at discharge.ResultsPVR was ≥moderate in 0.7% of S3 patients, 9.6% of NEO patients, 9.8% of ER patients and 0% of Lotus patients (p<0.001), and these differences remained after matching for total DLZ calcium volume. The amount of DLZ calcium was significantly related to the degree of PVR in patients treated with S3 (p=0.045), NEO (p=0.004) and ER (p<0.001), but not in Lotus patients (p=0.698). The incidence of PVR ≥moderate increased significantly over the tertiles of DLZ calcium volume (p=0.046). On multivariable analysis, calcification of the aortic valve cusps, LVOT calcification and the use of self-expanding transcatheter aortic valve implantation (TAVI) prostheses emerged as predictors of PVR.ConclusionsThe susceptibility to PVR depending on the amount of calcium was mainly observed in self-expanding TAVI prostheses. Thus, DLZ calcification is an important factor to be considered in prosthesis selection for each individual patient, keeping in mind the trade-off between PVR reduction, risk of new pacemaker implantation and unfavourable valve ha emodynamics.
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Ueno, Yohei, Teruhiko Imamura, Akira Oshima, Hiroshi Onoda, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno, and Koichiro Kinugawa. "Clinical Implications of Changes in Respiratory Instability Following Transcatheter Aortic Valve Replacement." Journal of Clinical Medicine 11, no. 1 (January 5, 2022): 280. http://dx.doi.org/10.3390/jcm11010280.

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Background: Respiratory instability, which can be quantified using respiratory stability time (RST), is associated with the severity and prognostic impact of the disease in patients with chronic heart failure. However, its clinical implications in patients with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR) remain unknown. Methods: Patients who received TAVR and had paired measurements of RST at a baseline and one week following TAVR were prospectively included. Changes in RST following TAVR and its impact on post-TAVR heart failure readmissions were investigated. Results: Seventy-one patients (median age, 86 years old; 35% men) were included. The baseline RST was correlated with the severity of heart failure including elevated levels of plasma B-type natriuretic peptide (p < 0.05 for all). RST improved significantly following TAVR from 34 (26, 37) s to 36 (33, 38) s (p < 0.001). Post-TAVR lower RST (<33 s, n = 18) was associated with a higher 2-year cumulative incidence of heart failure readmission (21% vs. 8%, p = 0.039) with a hazard ratio of 5.47 (95% confidence interval 0.90–33.2). Conclusion: Overall, respiratory instability improved following TAVR. Persistent respiratory instability following TAVR was associated with heart failure recurrence.
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Lind, Alexander, Rolf Alexander Jánosi, Matthias Totzeck, Arjang Ruhparwar, Tienush Rassaf, and Fadi Al-Rashid. "Embolic Protection with the TriGuard 3 System in Nonagenarian Patients Undergoing Transcatheter Aortic Valve Replacement for Severe Aortic Stenosis." Journal of Clinical Medicine 11, no. 7 (April 2, 2022): 2003. http://dx.doi.org/10.3390/jcm11072003.

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Background: Transcatheter aortic valve replacement (TAVR) improves the survival and life quality of nonagenarian patients with aortic stenosis. Stroke remains one of the most worrisome complications following TAVR. Cerebral embolic protection devices (CEPDs) may reduce neurological complications after TAVR. This study evaluated the safety and efficacy of CEPDs during TAVR in nonagenarian patients. Methods: Between January 2018 and October 2021, 869 patients underwent transfemoral TAVR (TF-TAVR) at our center. Of these, 51 (5.9%) patients were older than ninety years. In 33 consecutive nonagenarian patients, TF-TAVR was implanted without CEPDs using balloon-expandable valves (BEVs) and self-expandable valves (SEVs). Eighteen consecutive nonagenarians underwent TF-TAVR using a CEPD (CP group). Follow up period was in-hospital or 30 days after the procedure, respectively. Results: Minor access site complications occurred in two patients (3.9%) and were not CEPD-associated. Postinterventional delirium occurred in nine patients (17.6%). Periprocedural minor non-disabling stroke and delirium occurred in ten patients (19.6%). Periprocedural major fatal stroke occurred in two patients in the BEV group (3.9%). Two patients in the BEV group died due to postinterventional pneumonia with sepsis. The mortality rate was 7.8%. The results did not differ between the groups. Conclusions: Age alone is no longer a contraindication for TAVR. CEPD using the Triguard 3 system in nonagenarian TAVR patients was feasible and safe and did not increase access site complications.
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Henning, Kayley A., Mithunan Ravindran, Feng Qiu, Neil P. Fam, Tej N. Seth, Peter C. Austin, and Harindra C. Wijeysundera. "Impact of procedural capacity on transcatheter aortic valve replacement wait times and outcomes: a study of regional variation in Ontario, Canada." Open Heart 7, no. 1 (May 2020): e001241. http://dx.doi.org/10.1136/openhrt-2020-001241.

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BackgroundThere has been rapid growth in the demand for transcatheter aortic valve replacement (TAVR), which has the potential to overwhelm current capacity. This imbalance between demand and capacity may lead to prolonged wait times, and subsequent adverse outcomes while patients are on the waitlist. We sought to understand the relationship between regional differences in capacity, TAVR wait times and morbidity/mortality on the waitlist.Methods and resultsWe modelled the effect of TAVR capacity, defined as the number of TAVR procedures per million residents/region, on the hazard of having a TAVR in Ontario from April 2012 to March 2017. Our primary outcome was the time from referral to a TAVR procedure or other off-list reasons on the waitlist/end of the observation period as measured in days. Clinical outcomes of interest were all-cause mortality, all-cause hospitalisations or heart failure-related hospitalisations while on the waitlist for TAVR. There was an almost fourfold difference in TAVR capacity across the 14 regions in Ontario, ranging from 31.5 to 119.5 TAVR procedures per million residents. The relationship between TAVR capacity and wait times was complex and non-linear. In general, increased capacity was associated with shorter wait times (p<0.001), reduced mortality (HR 0.94; p=0.08) and all-cause hospitalisations (p=0.009).ConclusionsThe results of the present study have important policy implications, suggesting that there is a need to improve TAVR capacity, as well as develop wait-time strategies to triage patients, in order to decrease wait times and mitigate the hazard of adverse patient outcomes while on the waitlist.
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Klinkhammer, Brent. "Renin–angiotensin system blockade after transcatheter aortic valve replacement (TAVR) improves intermediate survival." Journal of Cardiovascular and Thoracic Research 11, no. 3 (August 13, 2019): 176–81. http://dx.doi.org/10.15171/jcvtr.2019.30.

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Introduction: Hypertension is common in patients with severe aortic stenosis undertaking transcatheter aortic valve replacement (TAVR). Renin–angiotensin system (RAS) blockade therapy with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) has recently been associated with improved outcomes after surgical aortic valve replacement and TAVR, but it is unknown if these findings apply to a more rural patient population. Methods: A retrospective cohort study of 169 patients with at least 1 year of post-TAVR follow-up at a single predominantly rural US center was performed to determine if RAS blockade after TAVR affects short- and long-term outcomes. Seventy-one patients were on an ACEI or ARB at the time of TAVR and at 1 year post-TAVR follow-up. Fisher’s exact test was used for categorical data and t-test/ANOVA was used to determine the statistical significance of continuous variables. Results: In a well-matched cohort, RAS blockade therapy post-TAVR was associated with significantly improved overall survival at 2 years (95% vs. 79%, P = 0.042). RAS blockade was also associated with a trend towards decreased heart failure exacerbations in the first year after TAVR, which was statistically significant in the 30 days to 6 months timeframe after TAVR (8% vs. 21%, P = 0.032). Conclusion: In a rural patient population, RAS blockade after TAVR is associated with improved overall survival and a trend towards decreased heart failure exacerbations. This study builds upon previous studies and suggests that TAVR should be considered a compelling indication for these agents.
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Mach, Markus, Sercan Okutucu, Tillmann Kerbel, Aref Arjomand, Sefik Gorkem Fatihoglu, Paul Werner, Paul Simon, and Martin Andreas. "Vascular Complications in TAVR: Incidence, Clinical Impact, and Management." Journal of Clinical Medicine 10, no. 21 (October 28, 2021): 5046. http://dx.doi.org/10.3390/jcm10215046.

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Transcatheter aortic valve replacement (TAVR) has replaced surgical aortic valve replacement as the new gold standard in elderly patients with severe aortic valve stenosis. However, alongside this novel approach, new complications emerged that require swift diagnosis and adequate management. Vascular access marks the first step in a TAVR procedure. There are several possible access sites available for TAVR, including the transfemoral approach as well as transaxillary/subclavian, transcarotid, transapical, and transcaval. Most cases are primarily performed through a transfemoral approach, while other access routes are mainly conducted in patients not suitable for transfemoral TAVR. As vascular access is achieved primarily by large bore sheaths, vascular complications are one of the major concerns during TAVR. With rising numbers of TAVR being performed, the focus on prevention and successful management of vascular complications will be of paramount importance to lower morbidity and mortality of the procedures. Herein, we aimed to review the most common vascular complications associated with TAVR and summarize their diagnosis, management, and prevention of vascular complications in TAVR.
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Veulemans, Verena, Amin Polzin, Oliver Maier, Kathrin Klein, Georg Wolff, Katharina Hellhammer, Shazia Afzal, et al. "Prediction of One-Year Mortality Based upon A New Staged Mortality Risk Model in Patients with Aortic Stenosis Undergoing Transcatheter Valve Replacement." Journal of Clinical Medicine 8, no. 10 (October 8, 2019): 1642. http://dx.doi.org/10.3390/jcm8101642.

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Background: In-depth knowledge about potential predictors of mortality in transcatheter aortic valve replacement (TAVR) is still warranted. Currently used risk stratification models for TAVR often fail to reach a holistic approach. We, therefore, aimed to create a new staged risk model for 1-year mortality including several new categories including (a) AS-entities (b) cardiopulmonary hemodynamics (c) comorbidities, and (d) different access routes. Methods: 737 transfemoral (TF) TAVR (84.3%) and 137 transapical (TA) TAVR (15.7%) patients were included. Predictors of 1-year mortality were assessed according to the aforementioned categories. Results: Over-all 1-year mortality (n = 100, 11.4%) was significantly higher in the TA TAVR group (TF vs. TA TAVR: 10.0% vs. 18.9 %; p = 0.0050*). By multivariate cox-regression analysis, a three-staged model was created in patients with fulfilled categories (TF TAVR: n = 655, 88,9%; TA TAVR: n = 117, 85.4%). Patients in “stage 2” showed 1.7-fold (HR 1.67; CI 1.07–2.60; p = 0.024*) and patients in “stage 3” 3.5-fold (HR 3.45; CI 1.97–6.05; p < 0.0001*) enhanced risk to die within 1 year. Mortality increased with every stage and reached the highest rates of 42.5% in “stage 3” (plogrank < 0.0001*), even when old- and new-generation devices (plogrank = n.s) were sub-specified. Conclusions: This new staged mortality risk model had incremental value for prediction of 1-year mortality after TAVR independently from the TAVR-era.
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Miranda, Rafael N., Feng Qiu, Ragavie Manoragavan, Stephen Fremes, Sandra Lauck, Louise Sun, Christopher Tarola, Derrick Y. Tam, Mamas Mamas, and Harindra C. Wijeysundera. "Drivers and outcomes of variation in surgical versus transcatheter aortic valve replacement in Ontario, Canada: a population-based study." Open Heart 9, no. 1 (January 2022): e001881. http://dx.doi.org/10.1136/openhrt-2021-001881.

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ObjectivesTo understand the patient and hospital level drivers of the variation in surgical versus trascatheter aortic valve replacement (SAVR vs TAVR) for patients with aortic stenosis (AS) and to explore whether this variation translates into differences in clinical outcomes.BackgroundAdoption of TAVR has grown exponentially worldwide. Notwithstanding, a wide variation in TAVR rates has been seen within and between countries and in some jurisdictions AS is still primarily being managed by SAVR.MethodsWe conducted a population-based retrospective cohort study in Ontario, Canada, including individuals who received TAVR or SAVR between 2016 and 2020. We developed iterative hierarchical logistic regression models for the likelihood of receiving TAVR instead of SAVR examining sequentially patient characteristics, hospital factors and year of procedure, calculating the median ORs and variance partition coefficients for each. Using Cox proportional hazards models, we examined the relationship between TAVR/SAVR ratio on all-cause mortality and readmissions.ResultsAnnual procedures rates per million population increased from 171 to 201, mainly driven by the expansion of TAVR. TAVR/SAVR ratios differed substantially between hospitals, from 0.21 to 3.27. Neither patient nor hospital factors explained the between-hospital variation in AS treatment. The TAVR/SAVR ratio was significantly associated with clinical outcomes with high ratio hospitals having lower mortality and rehospitalisations.ConclusionsDespite the expansion of TAVR, dramatic variation exists that is not explained by patient or hospital factors. This variation was associated with differences in clinical outcomes, suggesting that further work is needed in understanding and addressing inequity of access.
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De Palo, Micaela, Pietro Scicchitano, Pietro Giorgio Malvindi, and Domenico Paparella. "Endocarditis in Patients with Aortic Valve Prosthesis: Comparison between Surgical and Transcatheter Prosthesis." Antibiotics 10, no. 1 (January 6, 2021): 50. http://dx.doi.org/10.3390/antibiotics10010050.

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The interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Enterococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE).
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Grossman, Kelsey, Mathew R. Williams, and Homam Ibrahim. "Between a Rock and a Hard Place: How to Use Antithrombotics in Patients Undergoing Transcatheter Aortic Valve Replacement." US Cardiology Review 13, no. 2 (February 7, 2020): 88–93. http://dx.doi.org/10.15420/usc.2019.01.

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Transcatheter aortic valve replacement (TAVR) has become the preferred method for management of severe aortic stenosis in patients who are at high and intermediate surgical risk, and has recently gained approval from the Food and Drug Administration in the US for use in patients at low risk for surgery. Thrombocytopenia and thromboembolic events in patients undergoing TAVR is associated with increased morbidity and mortality, and yet there is insufficient evidence supporting the current guideline-mediated therapy for antithrombotics post-TAVR. In this article, the authors review current guidelines for antithrombotic therapy in patients undergoing TAVR, studies evaluating antiplatelet regimens, and studies evaluating the use of platelet function testing after TAVR. They also offer a potential link between thrombocytopenia and antiplatelet treatments in patients undergoing TAVR.
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Alvarez Velasco, R., I. Pascual Calleja, P. Avanzas Fernandez, M. Almendarez Lacayo, A. Adeba Garcia, YR Persia Paulino, M. Vigil-Escalera Diaz, and C. Moris De La Tassa. "Intraprocedural high degree atrioventricular block after transcatheter aortic valve replacement in patients with native versus bioprosthetic aortic valves." European Heart Journal. Acute Cardiovascular Care 10, Supplement_1 (April 1, 2021). http://dx.doi.org/10.1093/ehjacc/zuab020.214.

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Abstract Funding Acknowledgements Type of funding sources: None. Introduction One of the most frequent intraprocedural complication of patients undergoing transcatheter aortic valve replacement (TAVR) is high degree atrioventricular block (HDAVB). The incidence varies from 5-20% depending on the type of valve, previous surgical valve replacement (SVR) and basal conduction disturbances. Purpose The purpose of this study was to evaluate the incidence of intraprocedural HDAVB in patients undergoing TAVR in native valves versus patients with previous SVR derived for valve-in-valve TAVR (VIV-TAVR). Methods Data was collected from all the patients undergoing TAVI in a single center from December 2007 to July 2019. The primary endpoint was to compare the incidence of HDAVB in patients undergoing TAVR versus patients undergoing VIV-TAVI. The secondary endpoint was to describe the differences in the baseline characteristics of patients that presented with HDAVB vs patients without HDAVB. Results A total of 661 patients were derived for TAVR and separated into 2 groups for analysis. 596 patients with native valves treated with TAVR and 65 patients with previous SVR treated with VIV-TAVI. The primary outcome was present in 87 patients (14,6%) in the TAVR group vs 1 patient (1,54%) in the VIV-TAVR group (p: 0,0033). Patients with HDAVB (n = 88) had a mean age of 83,1 ± 6,26 years. The baseline EKG showed a conduction disturbance in 47,6% of the cases (50% of right bundle branch block; 21,8% of first degree AVB; 15,09% of left bundle branch block and 35,85% of left anterior fascicular block). A new permanent pacemaker was implanted in 77 (87,5%) patients. Patients without HDAVB (n = 573) had a mean age of 82,5 ± 6,14 years. The baseline EKG showed a conduction disturbance in 28,91% of the cases (22,73% of Right bundle branch block; 25,68% of first degree AVB; 31,70% of left bundle branch block and 21,25% of left anterior fascicular block). A new permanent pacemaker was implanted in 59 (10,30%) patients. Conclusions There is a very low incidence of intraprocedural HDAVB in patients undergoing VIV-TAVR compared to the rest of TAVR procedures (1,54% vs 14,6% p:0,0033). Moreover, the only predictors that associated with the development of HDAVB where previous right bundle branch block and left anterior fasicular hemiblock. The development of intraprocedural HDAVB is associated with the need of a new permanent pacemaker. Table 1: Basal CharacteristicsNo HDAVBHDAVBp VALUEAge, yrs82,683,10,453Basal conduction disturbance28,91 %47,62 %&lt;0,0001PPM implantation10,3 %85,2 %&lt;0,0001Basal characteristicsAbstract Figure. Clinical characteristics by groups
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Oikonomou, G., M. Drakopoulou, S. Soulaidopoulos, P. Toskas, K. Stathogiannis, M. Xanthopoulou, K. Toutouzas, and D. Tousoulis. "P1817 The effect of permanent pacemaker implantation following transcatheter aortic valve replacement upon survival." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.1165.

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Abstract Background Transcatheter aortic valve replacement (TAVR) is often followed by conduction abnormalities, leading to a permanent pacemaker implantation (PPI). Data regarding the clinical impact of PPI following TAVR is yet to be established. Purpose To determine the effect of PPI after TAVR on long-term survival. Methods : Patients with severe and symptomatic aortic stenosis [effective orifice area (EOA)≤1cm2] referred for TAVI at our institution were consecutively enrolled. Prospectively collected demographic, laboratory and echocardiographic data were retrospectively analyzed. Patients were stratified into two groups according to the need for PPI after TAVR and were followed up postoperatively with clinical and echocardiographic assessment. Primary clinical endpoint was all-cause mortality, as defined by the criteria proposed by the Valve Academic Research Consortium2. Results : In total, 276 patients were included (male : 48.9%, mean age : 80 ± 7.5years) in our study . Of these, 107 (38.8%) underwent PPI simultaneously or shortly after TAVR. The median follow-up period was 26.6 [min. 0, max 116] months. In this period, all-cause mortality showed no significant difference between patients with and those without PPI after TAVR (log-rank p = 0.862). Subgroup analysis also showed no difference in survival between patients with low ejection fraction (&lt;50%) and those with preserved (≥50%) receiving a permanent pacemaker after TAVR (log-rank p = 0.360). Including factors that were found to associate to PPI in univariate analysis (pre TAVR - ejection fraction, pulmonary artery systolic pressure and New York Heart Association functional class) in a multivariate model, pre TAVR pulmonary artery systolic pressure was found to be an independent predictor of peri-procedural PPI [Exp(B) : 0.974, 95% Confidence Interval : 0.953- 0.995, B= - 0.027, p= 0.015]. Conclusion : PPI following TAVR was not associated with survival at 26 months of follow-up, independently from the pre TAVR ejection fraction. Abstract P1817 Figure.
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Furuichi, Y., J. Shimizu, and R. Higuchi. "P112 Early respiratory changes after transcatheter aortic valve replacement." European Heart Journal 41, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/ehz872.052.

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Abstract Funding Acknowledgements Sakakibara heart Institute Introduction Transcatheter aortic valve replacement (TAVR) is an alternative treatment for inoperative or high-risk patients requiring surgical aortic valve replacement (SAVR). In previous studies, the vital capacity falls to about 50% immediately after SAVR. Although the vital capacity recovers to about 60-70% in one week, it does not recover to preoperative levels at 3 months following SAVR 1)2). TAVR is expected to preserve respiratory function because TAVR does not require a sternotomy. Purpose The purpose of this study was to investigate early stage respiratory function after a TAVR. We assumed that respiratory function is not reduced after a TAVR. Methods This prospective study was approved by the local ethics committee of our Institute. Written informed consent was obtained from all patients. The subjects were patients who underwent TAVI at our Institute from July 2017 to March 2019. Exclusion criteria included patients who refused to provide informed consent, emergent cases, NYHA (New York Heart Association) Class IV patients, patients receiving inotropes, patients under mechanical ventilation, patients enrolled in other studies, or patients for whom conducting pulmonary function tests were judged to be difficult. The pulmonary function test was conducted once a day until one week after the TAVR procedure. Results The target number was 100, and we ceased registration when informed consent was obtained from 100 patients. TAVR was conducted for 142 cases in this period and 42 cases were excluded. After informed consent was obtained, 17 cases were excluded because they met the exclusion criteria, and the analysis was conducted with 83 cases. The vital capacity and % of vital capacity were significantly reduced from the first day to the sixth day and recovered to preoperative levels at the seventh day after TAVR. The forced expiratory volume was significantly reduced from the first day to the fifth day, and recovered to preoperative levels at the sixth day after TAVR. The percentage of forced expiratory volume at one second was not significantly reduced. Conclusions The respiratory function was reduced in the early stages after TAVR. The respiratory function was reduced mostly on the first day after TAVR and recovered to preoperative levels on the seventh day after TAVR. After TAVR, the respiratory function recovered earlier than after SAVR. We believe that TAVR is more suitable for patients with reduced respiratory function. Abstract P112 Figure. respiratory function after TAVR
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Gupta, R., S. Mahajan, A. Malik, S. Mehta, and N. Patel. "Comparing predictors of permanent pacemaker insertion after TAVR in new-generation versus early generation heart valves." European Heart Journal 42, Supplement_1 (October 1, 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.0405.

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Abstract Introduction Transcatheter Aortic Valve Replacement (TAVR) has emerged as the standard of care for patient with severe aortic stenosis. Conduction abnormalities leading to permanent pacemaker (PPM) implantation is one of the most common complication after TAVR. Newer generation valves (NGV) such as Sapien S3, XT and Evolut are widely being used in real time practice. The aim of this analysis is to compare the predictors associated with increased risk of PPM implantation after TAVR in newer generation valves (NGV) as compared to older generation valves (OGV). Methods A comprehensive literature search was performed in PubMed, Embase, and Cochrane to identify relevant trials. Summary effects were calculated using a DerSimonian and Laird random-effects model as odds ratio with 95% confidence intervals for all the clinical endpoints. Results 18 observational studies with 16,004 patients were identified. The incidence of PPM implantation after TAVR in our analysis was 8.9%. For the NGV, right bundle branch block (RBBB) and atrioventricular (AV) block were independent predictors of PPM insertion after TAVR. Baseline heart rate, presence of atrial fibrillation, and baseline intraventricular conduction delay were not significant predictors. However, for the OGV, risk of PPM implantation after TAVR was higher in presence of RBBB, depth of implant, valve size/annulus size, presence of atrial fibrillation and post-procedure AV block. Conclusions Our analysis identified 2 factors that were significantly associated with increased risk of PPM insertion after TAVR in NGV compared to 6 factors with OGV. With the increasing physician expertise with TAVI and use of NGV, the incidence of post TAVR PPM insertion has reduced but baseline RBBB and AV conduction block still continue to be significant predictors of increased PPM insertion after TAVR. Funding Acknowledgement Type of funding sources: None.
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Hatam, N., S. Donuru, G. Musetti, S. H. Lotfi, K. Spetsotaki, H. Steffen, R. Autschbach, and R. Zayat. "P1574 Variation in myocardial work performance after surgical and transcather aortic valve replacement: A pilot echocardiographic study." European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.994.

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Abstract Funding Acknowledgements none Objective Perioperative myocardial injury occurs after surgical aortic valve replacement (SAVR) as well as after transcather aortic valve replacement (TAVR). The novel non-invasive method for regional LV pressure– strain corresponds well with invasively measured myocardial work (MW) and is independent of afterload compared to ejection fraction and global longitudinal strain (GLS) . In this pilot study, we aimed to compare changes of LV-MW index (MWI) between SAVR and TAVR in the early postoperative period. Methods 25 TAVR (Corevalve & Symetis) and 25 SAVR (Perimount) patients, scheduled for elective procedures received transthoracic echocardiography studies pre- and 7 days postoperatively. Besides routine measurements the following parameters were analyzed: MWI, global MW efficiency (MWE), global wasted myocardial work (GWMW), GLS and global strain rate (GSR). Results In the TAVR group, 17 patients received transfermoral, 8 patients transapical TAVR. As expected, EuroSCORE II was significantly higher in the TAVR group (p = 0.015). GLS was significantly lower (better) in the SAVR group compared to the TAVR group preoperatively (-13.4 + 4.9 vs.-16.7 ± 4.2, p = 0.027). Postoperative GLS increased (worsened) in the SAVR group, though no significant difference was detected between the groups (-12.7 ± 5.1% vs. -10.4 ± 3.4%, p = 0.215) postoperatively. MWI was significantly lower in the TAVR group preoperatively (p = 0.033). Within the TAVR group MWI did not decrease significantly postoperatively (1242 mmHg% vs. 1108 mmHg%, p = 0.476). However, postoperative MWI decreased significantly in the SAVR group (1632 mmHg% vs. 1267mmHg%, p = 0.043). MWE and GWMW did not differ between the groups or within the groups comparing pre- and postoperative values. Conclusion Despite better GLS values in SAVR patients preoperatively, we could detect a better preservation of GMWI in TAVR Patients postoperatively. To evaluate the clinical impact of MWI, further studies with larger cohort and correlation with biomarkers of myocardial injury and follow-up assessments are required. Abstract P1574 Figure. Myocardial work changes after TAVI
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47

Miyamoto, J., Y. Ohno, Y. Ikari, N. Tada, T. Naganuma, M. Yamawaki, F. Yamanaka, et al. "Impact of periprocedural pulmonary hypertension on outcomes after TAVR: novel risk stratification from the OCEAN-TAVI Registry." European Heart Journal 43, Supplement_2 (October 1, 2022). http://dx.doi.org/10.1093/eurheartj/ehac544.2110.

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Abstract Aim There are limited data on prognostic impact of periprocedural pulmonary hypertension (PH) after transcatheter aortic valve replacement (TAVR). The aim of this study was to investigate the prognostic impact of normalized, new-onset, and residual PH after TAVR. Methods and results OCEAN-TAVI registry is an ongoing, multicenter Japanese registry which includes 2588 patients who underwent TAVR. Patients were classified into 4 groups according to periprocedural systolic pulmonary artery pressure (sPAP) by echocardiography: pre-no PH/post-no PH (no PH) group, pre-PH/post-no PH (normalized PH) group, pre-no PH/post-PH (new-onset PH) group, and pre-PH/post-PH (residual PH) group. PH was defined as sPAP&gt;36mmHg. Primary endpoint was all-cause mortality at 2 years. Logistic regression analysis was used to identify the clinical predictors of residual and new-onset PH. In total, 1872 patients were divided into 4 groups: 1027 patients (54.9%) in the no PH, 257 patients (13.7%) in the normalized PH, 280 patients (15.0%) in the new-onset PH, and 308 patients (16.5%) in the residual PH group, respectively. There was a significant difference in all-cause mortality among the 4 groups at 2 years (11.0%, 12.8%, 18.6%, and 24.7%, respectively; P&lt;0.01). Among 565 patients who had pre-procedural PH, 257 patients (45.5%) experienced normalization of PH with mortality comparable with no PH group. In multivariable logistic regression analysis, predictors of residual PH after TAVR were atrial fibrillation and baseline tricuspid regurgitation&gt;moderate, whereas prosthesis-patient mismatch (PPM) was a predictor of new-onset PH. Conclusions Risk stratification based on improvement in PH or new-onset/residual PH after TAVR can identify patients at increased mortality after TAVR. PPM was identified as a novel predictor of new-onset PH. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): The OCEAN-TAVI registry is supported by Edwards Lifesciences, Medtronic Japan, Boston Scientific, Abbott Medical, and Daiichi-Sankyo company.
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Elbaz -Greener, Gabby, Shannon Masih, Jiming Fang, Dennis T. Ko, Sandra B. Lauck, John G. Webb, Brahmajee K. Nallamothu, and Harindra C. Wijeysundera. "Abstract 179: Temporal Trends and Clinical Consequences of Wait-Times for Trans-Catheter Aortic Valve Replacement: A Population Based Study." Circulation: Cardiovascular Quality and Outcomes 11, suppl_1 (April 2018). http://dx.doi.org/10.1161/circoutcomes.11.suppl_1.179.

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Background: Trans-catheter aortic valve replacement (TAVR) represents a paradigm shift in the therapeutic options for patients with severe aortic stenosis. However, rapid and exponential growth in TAVR demand may overwhelm capacity, translating to inadequate access and prolonged wait-times. Our objective was to evaluate temporal trends in TAVR wait-times and the associated clinical consequences. Methods: In this population-based study in Ontario, Canada, we identified all TAVR referrals from April 1, 2010 to March 31, 2016. The primary outcome was the median total wait-time from referral to procedure. Piecewise regression analyses were performed to assess temporal trends in TAVI wait-times, before and after provincial reimbursement in September 2012. Clinical outcomes included all-cause death and heart failure hospitalizations while on the wait-list. Results: The study cohort included 4,461 referrals, of which 50% led to a TAVR, 39% were off-listed for other reasons and 11% remained on the wait-list at the conclusion of the study. For patients who underwent a TAVR, the estimated median wait-time in the post-reimbursement period stabilized at 82-84 days, and has remained unchanged since September 2012. The cumulative probability of wait-list mortality and heart failure hospitalization was 4.3% and 14.7% respectively, with a relatively constant increase in events with increased wait-times. Conclusion: Post-reimbursement wait-time has remained unchanged for patients undergoing a TAVR procedure, suggesting the increase in capacity has kept pace with the increase in demand. The current wait-time of almost 3 months is associated with important morbidity and mortality, suggesting a need for greater capacity and access.
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Kobari, Yusuke, Taku Inohara, Tetsuya Saito, Nobuhiro Yoshijima, Makoto Tanaka, Hikaru Tsuruta, Fumiaki Yashima, et al. "Aspirin Versus Clopidogrel as Single Antithrombotic Therapy After Transcatheter Aortic Valve Replacement: Insight From the OCEAN-TAVI Registry." Circulation: Cardiovascular Interventions 14, no. 5 (May 2021). http://dx.doi.org/10.1161/circinterventions.120.010097.

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Background: Current guidelines recommend dual antiplatelet therapy for the first 1 to 6 months after transcatheter aortic valve replacement (TAVR); however, recent studies have reported better outcomes with single antiplatelet therapy than with dual antiplatelet therapy in the occurrence of bleeding events, while not increasing thrombotic events. However, no data exist about optimal single antiplatelet therapy following TAVR. Methods: Patients who underwent TAVR between October 2013 and May 2017 were enrolled from the OCEAN-TAVI Japanese multicenter registry (Optimized Transcatheter Valvular Intervention). After excluding 1759 patients, 829 who received aspirin (100 mg/d) or clopidogrel (75 mg/d) after TAVR were identified and stratified according to the presence or absence of anticoagulation. Propensity score matching was performed to adjust the baseline characteristics between the aspirin and clopidogrel groups. Outcomes of interest were all-cause and cardiovascular deaths, stroke, and life-threatening or major bleeding within 2 years following TAVR. Results: After propensity score matching, 98 and 157 pairs of patients without and with anticoagulation, respectively, were identified. Falsification end points of pneumonia, urinary tract infection, and hip fracture were evaluated, and their rates were not different between groups. All-cause deaths were not statistically different between the groups in patients with (aspirin, 17.5%; clopidogrel, 11.1%; log-rank P =0.07) and without (aspirin, 29.6%; clopidogrel, 20.1%; log-rank P =0.15) anticoagulation at 2 years post-TAVR, whereas clopidogrel was associated with a lower cardiovascular mortality at 2 years in patients with (aspirin, 8.5%; clopidogrel, 2.7%; log-rank P =0.03) and without (aspirin, 18.0%; clopidogrel, 5.2%; log-rank P =0.02) anticoagulation. Conclusions: We demonstrated that clopidogrel monotherapy was associated with a lower incidence of cardiovascular death compared with aspirin monotherapy during the 2-year follow-up after TAVR regardless of anticoagulation use. Registration: URL: https://upload.umin.ac.jp ; Unique identifier: UMIN000020423.
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Munoz-Garcia, E., M. Munoz-Garcia, A. J. Munoz Garcia, A. J. Dominguez-Franco, F. Carrasco-Chinchilla, J. H. Alonso-Briales, J. M. Hernandez-Garcia, J. J. Gomez-Doblas, and M. F. Jimenez-Navarro. "P5576Outcomes and clinical impact of mitral regurgitation in patients with aortic stenosis undergoing with transcatheter aortic valve replacement." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz746.0520.

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Abstract Background Many patients undergoing Trancatheter aortic valve replacement (TAVR) for aortic stenosis also have significant mitral regurgitation (MR). We sought to understand the association of concomitant MR with TAVR clinical outcomes, as well changes in MR after TAVR. Methods Patients who underwent TAVR at our center, between April 2008 to December 2017, were studied, with longer-term clinical outcomes. Results Of 667patients, 92 (13.8%) had moderate MR, and 47 (2.1%) had severe MR. At 3.2±2.2 years, mortality was 39.4%, 46.1%, 39.1%, 57.6% and 50% and heart failure (HF) rehospitalization was 7%, 7.9%, 17.6%, 21.9% and 46.2% (p<0.001) in the no, mild, moderate, moderate-severe and severe MR patients, respectively. After procedure, 64 patients (9.9%) had moderate MR and 24 patients (3.7%) had severe MR. At follow-up, the mortality was 35.9%, 46.5%, 48.4%, 52.9% and 85.7%, p<0.001 and HF rehospitalization 9.1%, 5.5%, 23.4%, 35.3% and 40% in the no, mild, moderate, moderate-severe and severe MR patients, respectively. MR improved early after TAVI grade in 88 patients (13.2%). Baseline MR is not associated with mortality (HR= 0.883 [95 CI 0.708–1.102], p=0.114), but MR post-TAVR was associated with increase risk of mortality (HR= 1.539 [95 CI 1.187–1.996], p=0.001. In 7 patients with persistent MR received percutaneous mitral repair with MitraClip®. Conclusions In our series, Moderate or severe MR after TAVR is associated with increased mortality or HF rehospitalization, this increased risk may be attributable to the minority of patients whose MR does not improve and could benefit from percutaneous mitral procedures (Mitraclip®).
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