Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation

Abstract ObjectivesWe aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). BackgroundsLVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. MethodsA total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient>30 mm Hg. ResultsOver 1 year of follow‐up after TAVI, 21 patients (13.3%) demonstrated postprocedural LVO. The incidence was highest at 3‐months follow‐up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2%) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8%) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.30–0.67; P 
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: VSD ‐ VALVULAR AND STRUCTURAL HEART DISEASES Source Type: research

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There has been an ongoing evolution in our understanding and subsequent management of the patient with aortic stenosis (AS). Valvular AS presents a mechanical obstruction to ventricular ejection at the aortic valve level, worsens over time, and with the onset of symptoms there is a rapidly declining course resulting in progressive heart failure and death. The advent of surgical aortic valve replacement (SAVR) nearly 60 years ago has been lifesaving for many patients with symptomatic severe AS, restoring quality of life to those with severe limiting symptoms.
Source: Mayo Clinic Proceedings - Category: Internal Medicine Authors: Tags: Editorial Source Type: research
This study aimed to evaluate the effect of the initial aortic valve replacement (AVR) strategy relative to a conservative strategy on long-term outcomes stratified by age among asymptomatic patients with severe aortic stenosis (AS).Methods and Results:Among 1,808 asymptomatic severe AS patients in the CURRENT AS registry, there were 1,166 patients aged ≥75 years (initial AVR: n=124, and conservative: n=1,042), and 642 patients with age
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Publication date: January 2020Source: Canadian Journal of Cardiology, Volume 36, Issue 1Author(s): Mohammad Alkhalil, Paul Brennan, Conor McQuillan, Reuben Jeganathan, Ganesh Manoharan, Colum G. Owens, Mark S. SpenceAbstractBackgroundTools are needed to identify patients at increased risk after transcatheter aortic valve replacement (TAVR). Indexed stroke volume (SVi) is an echocardiographic measurement that is used for low-gradient aortic stenosis. We studied whether low SVi is a high-risk marker in patients with high-gradient aortic stenosis (HG-AS) and assessed the relationship between SVi and left ventricle (LV) systol...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractHeart failure with reduced ejection fraction (HFrEF) is common in patients with adult congenital heart disease. Many of the most common congenital defects have a high prevalence of HFrEF, including left-sided obstructive lesions (aortic stenosis, coarctation of the aorta, Shone complex), tetralogy of Fallot, Ebstein anomaly, lesions in which there is a systemic right ventricle, and lesions palliated with a Fontan circulation. However, heart failure with preserved ejection fraction (HFpEF) is also prevalent in all these lesions. Comprehensive evaluation includes physical exam, biomarkers, echocardiography and advanc...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
ConclusionsThis analysis shows that there are 3 distinct phases of cost accumulation from referral to post-TAVR with some potentially modifiable cost drivers in each phase.
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
CHAD-STOP is the mnemonic for the initial steps in the management of cardiac amyloidosis: C: Conduction and rhythm disorder prevention H: High heart rate maintenance A: Anticoagulation D: Diuretics STOP: STOP beta receptor and calcium channel blockers, digoxin and renin-angiotensin-aldosterone inhibitors Preload reserve is limited in cardiac amyloidosis due to severe diastolic dysfunction. Hence the only way to increase the cardiac output is by the heart rate reserve and hence it should not be cut down by beta blockade or calcium channel blockade. Renin-angiotensin-aldosterone inhibitors carry the risk of severe hypotens...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology Source Type: blogs
ConclusionTakotsubo cardiomyopathy may develop in critically ill cardiac diseases but are often underdiagnosed. Careful echocardiographic examination is needed to unveil these “hidden” TC.
Source: Journal of Echocardiography - Category: Cardiology Source Type: research
Computed tomography angiography derived global longitudinal strain (CTA-GLS) has been shown to be feasible, however its prognostic value remains unclear in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). We evaluated the association of baseline CTA-GLS with outcomes including all-cause mortality and composite endpoint of death and heart failure hospitalization in 223 patients treated with TAVR. Patients with normal LVEF but reduced CTA-GLS had similar event rate to those with impaired LVEF, and higher than those with normal LVEF and preserved CTA-GLS. Baseline CTA-GLS assessme...
Source: Journal of Cardiovascular Computed Tomography - Category: Radiology Authors: Source Type: research
Conclusions: This study unravels the complex transcriptome profiles of the heart tissues and highlighting the candidate genes involved in cardiac remodeling induced by mechanical stress may usher in a new era of precision diagnostics and treatment in patients with cardiac remodeling. PMID: 31772688 [PubMed - in process]
Source: Disease Markers - Category: Laboratory Medicine Tags: Dis Markers Source Type: research
CONCLUSIONS: Within nonagenarians with AS, patients treated with TAVI had lower risk of cardiovascular events than matched patients treated medically. The patients undergoing a TAVI at this age were often highly selected and the procedure was associated with acceptable long term outcomes. PMID: 31763981 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
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