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Perioperative Bleeding Requiring Blood Transfusions Is Associated with Increased Risk of Stroke after Transcatheter and Surgical Aortic Valve Replacement
We aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) from the FinnValve registry.
Source: Journal of Cardiothoracic and Vascular Anesthesia - April 26, 2022 Category: Anesthesiology Authors: Tuomas Tauriainen, Tatu Juvonen, Vesa Anttila, Pasi Maaranen, Matti Niemel ä, Markku Eskola, Tuomas Ahvenvaara, Annastiina Husso, Marko P.O. Virtanen, Eeva-Maija Kinnunen, Sebastian Dahlbacka, Maina Jalava, Mika Laine, Antti Valtola, Peter Raivio, Antti Tags: Original Article Source Type: research

Self-Expanding Versus Balloon-Expandable Valve: Are We at the Cusp of Delivering a Perfect Transcatheter Aortic Valve?
Transcatheter aortic valve replacement (TAVR) has become a leading and dominant treatment alternative to surgical aortic valve replacement (SAVR) for intermediate- and high-risk patients with aortic stenosis.1-5 The follow-up trials for both the core valve, as well as the balloon-expanding valve, showed similar midterm survival and stroke rates in high-risk patients following TAVR versus SAVR.6-8 With the recent results of the PARTNER 3 and EVOLUT low-risk trials, it is evident that, among patients with severe aortic stenosis with low surgical risks, the rates of composite death, stroke, and rehospitalization at 1 year wer...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 26, 2021 Category: Anesthesiology Authors: Ankit Jain Tags: Editorial Source Type: research

Self-Expanding versus Balloon Expandable Valve – Are we at the Cusp of Delivering a Perfect Transcatheter Aortic Valve?
Transcatheter aortic valve replacement (TAVR) has become a leading and dominant treatment alternative to surgical aortic valve replacement (SAVR) for high- and intermediate-risk patients with aortic stenosis.1 –5 The follow up trials for both the core valve as well as the balloon-expanding valve showed similar mid-term survival and stroke rates in high-risk patients following TAVR vs SAVR.6–8 With the recent results of the PARTNER 3 and EVOLUT low risk trials, it is evident that, among patients with s evere aortic stenosis with low surgical risks, the rate of composite death, stroke and rehospitalization at 1 year was ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 26, 2021 Category: Anesthesiology Authors: Ankit Jain Tags: Editorial Source Type: research

The PARTNER 3 Trial at Two Years: What We Have Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the US Food and Drug Administration (FDA) has approved both balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) devices for use in aortic stenosis patients at low, intermediate, and high risk for surgical aortic valve replacement (SAVR).1-6 High-risk device approval was based on one-year data, which was reasonable due to the actuarial life expectancies of the cohort.1,2 Intermediate-risk approval for the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) system was based largely on data from the Placeme...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Tags: Editorial Source Type: research

The PARTNER 3 Trial at 2 Years: What We've Learned and What Time Will Tell
Based on data from large, industry-sponsored randomized prospective studies, the United States Food and Drug Administration (FDA) has approved both balloon-expandable and self-expanding transcatheter aortic valve replacement (TAVR) devices for use in aortic stenosis patients at low, intermediate and high-risk for surgical aortic valve replacement (SAVR).1-6 High-risk device approval was based on 1-year data, which was reasonable due to the actuarial life expectancies of the cohort.1, 2 Intermediate-risk approval for the balloon-expandable Sapien XT (Edwards Lifesciences, Irvine, California) system was largely based on data...
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 28, 2021 Category: Anesthesiology Authors: Peter J. Neuburger, Kinjal M. Patel, Prakash A. Patel Source Type: research

A Case of Successful Treatment of Cerebral Embolism Using Endovascular Thrombectomy Immediately After Transcatheter Aortic Valve Implantation
TRANSCATHETER aortic valve implantation (TAVI) is a less invasive alternative to surgical aortic valve replacement in high-risk patients with severe aortic stenosis. However, there are increasing concerns about the potential complications of TAVI now that its indications have been expanded to include patients with low-to-intermediate surgical risk.1,2 One of the serious complications of TAVI is stroke. It is known that there is an increase in 30-day mortality, rates of respiratory insufficiency and postprocedural delirium, and duration of hospital stay if stroke occurs.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 17, 2019 Category: Anesthesiology Authors: Shunichi Murakami, Kazuyoshi Ishida, Hideyuki Ishihara, Takayuki Okamura, Tetsuro Oda, Ryo Suzuki, Atsuo Yamashita, Satoshi Yamashita, Hiroshi Kurazumi, Michiyasu Suzuki, Mishiya Matsumoto Tags: Case Report Source Type: research

Left Atrial Thrombus Formation in a Patient With Severe Non-rheumatic Mitral Stenosis After Mitral Valve Repair Receiving Dual Antiplatelet Therapy: A Clinical Challenge
A 60-YEAR-OLD, 88-kg, 165-cm woman presented to a community hospital with heart failure 5 years after mitral valve repair for mitral regurgitation. The patient previously suffered an ischemic stroke and was currently treated with dual antiplatelet therapy. Transesophageal echocardiography revealed severe mitral stenosis with a mean transmitral gradient of 10 mmHg and thickening of the posterior left atrial wall. The patient was then transferred to the authors ’ institution for mitral valve replacement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 10, 2019 Category: Anesthesiology Authors: Michael Essandoh, Amir Elhassan, Thomas J. Papadimos, Brandon Pruett, Gregory D. Rushing Tags: Diagnostic Dilemma Source Type: research

Myocardial Protection During Minimally Invasive Mitral Valve Surgery: Is Retrograde Cardioplegia Alone Enough?
Minimally invasive mitral valve surgery is a commonly performed procedure in contemporary cardiac surgery.1-3 The surgical exposure for minimally invasive mitral valve surgery (right anterolateral minithoracotomy) provides very limited access to the aorta and makes myocardial protection with antegrade cardioplegia challenging.1,3 Early experiences used an endo-aortic balloon to administer antegrade cardioplegia, and retrograde cardioplegia was administered through a coronary sinus catheter.3 The endo-aortic balloon approach was associated with complications such as aortic dissection and stroke and has fallen out of favor in some centers.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 17, 2019 Category: Anesthesiology Authors: Michael Essandoh Tags: Letter to the Editor Source Type: research

Percutaneous Coronary Artery Revascularization and Transcatheter Aortic Valve Replacement: Is There a Who, Why, and When?
WITH A PREVALENCE in aortic stenosis (AS) patients of 25% to 50%, concomitant coronary artery disease (CAD) has proven to be an independent risk factor for patients undergoing transcatheter aortic valve replacement (TAVR).1 Currently there is no standard- or guideline-driven approach for these patients, and many new challenges have emerged in this population. In this issue of the Journal of Cardiothoracic and Vascular Anesthesia, Bacigalupo et al.2 report a case of a patient with recent percutaneous coronary intervention (PCI) for obstructive CAD who underwent TAVR complicated by in-stent thrombosis and an ischemic stroke ...
Source: Journal of Cardiothoracic and Vascular Anesthesia - February 20, 2019 Category: Anesthesiology Authors: Oscar D. Aljure, Michael Fabbro Tags: Editorial Source Type: research

Analysis of Neurologic Complications After Surgical Versus Transcatheter Aortic Valve Replacement
Ove the last decade, transcatheter aortic valve replacement (TAVR) has emerged as the recommended approach over surgical aortic valve replacement (SAVR) for many patients with aortic stenosis. While initial trials demonstrated a higher incidence of stroke with TAVR compared to SAVR, the incidence of stroke appears to have improved over time. With the increasing number of patients expected to undergo TAVR in the coming decades, it is important to review the incidence and etiology of stroke after SAVR and TAVR.
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 27, 2018 Category: Anesthesiology Authors: Sundar Krishnan, Archit Sharma, Sudhakar Subramani, Lovkesh Arora, Divyanshu Mohananey, Pedro Villablanca, Harish Ramakrishna Tags: Expert Review Source Type: research

A Rare Cause of Stroke FourWeeks After Ascending Aortic Aneurysm Repair
A 71-YEAR-OLD, 97 kg, 178 cm man with a history of a slowly expanding 5.4 cm ascending aortic aneurysm, bicuspid aortic valve disease without stenosis, hypertension, hyperlipidemia, type II diabetes mellitus, and hemodynamically insignificant coronary artery disease underwent ascending aortic replacement using a woven synthetic graft. The patient's postoperative course was complicated by persistent sternal drainage that required exploration, evacuation of pericardial fluid, and antibiotic treatment, but he otherwise made an uneventful recovery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 4, 2018 Category: Anesthesiology Authors: Graham E.D. Hill, Patrick S. Aranda, Julie F. Harvey, Timothy J. Olund, G. Hossein Almassi, Lyle D. Joyce, Paul S. Pagel Tags: Diagnostic Dilemma Source Type: research

A Rare Cause of Stroke Four Weeks After Ascending Aortic Aneurysm Repair
A 71-YEAR-OLD, 97 kg, 178 cm man with a history of a slowly expanding 5.4 cm ascending aortic aneurysm, bicuspid aortic valve disease without stenosis, hypertension, hyperlipidemia, type II diabetes mellitus, and hemodynamically insignificant coronary artery disease underwent ascending aortic replacement using a woven synthetic graft. The patient's postoperative course was complicated by persistent sternal drainage that required exploration, evacuation of pericardial fluid, and antibiotic treatment, but he otherwise made an uneventful recovery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 3, 2018 Category: Anesthesiology Authors: Graham E.D. Hill, Patrick S. Aranda, Julie F. Harvey, Timothy J. Olund, G. Hossein Almassi, Lyle D. Joyce, Paul S. Pagel Tags: Diagnostic Dilemma Source Type: research

Anesthesia Matters: In Pursuit of the Interventions that Affect Outcomes in Transcatheter Aortic Valve Replacement
FOR THE LAST 15 years, clinical research into transcatheter aortic valve replacement (TAVR) was focused chiefly on device technology, periprocedural imaging, and patient selection.1 –3 Early challenges included vascular access, valve positioning, and valve performace.4,5 The time and resources dedicated to the study of these areas have led to a better understanding of which patient should get which procedure and prosthesis, resulting in improvements in outcomes including deat h, stroke, and recovery that now match or exceed surgical aortic valve replacement.
Source: Journal of Cardiothoracic and Vascular Anesthesia - March 2, 2018 Category: Anesthesiology Authors: Peter J. Neuburger, Prakash A. Patel Tags: Editorial Source Type: research

Stroke After Transcatheter Aortic Valve Replacement: Incidence, Definitions, Etiologies and Management Options
Neurologic complications after transcatheter aortic valve replacement are devastating. The etiologies of stroke in this setting are best addressed in an integrated fashion during each phase of the perioperative pathway. The conduct of this triphasic approach will continue to be refined to reduce the stroke risks even further, given the major focus on aspects such as embolic protection devices and valve thrombosis. This neurologic focus in transcatheter aortic valve replacement has transformed the investigational approach to neurologic events in cardiovascular clinical trials, resulting in novel guidelines for the diagnosis...
Source: Journal of Cardiothoracic and Vascular Anesthesia - November 22, 2017 Category: Anesthesiology Authors: Prakash A. Patel, Saumil Patel, Jared W. Feinman, Jacob T. Gutsche, Prashanth Vallabhajosyula, Ronak Shah, Jay Giri, Nimesh D. Desai, Elizabeth Zhou, Stuart J. Weiss, John G. Augoustides Tags: Review Article Source Type: research

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