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To examine the incidence and trends of peri-procedural complications after TAVR and their impact on resource utilization.The incidence of complications by type [acute kidney injury (AKI), permanent pacemaker (PPM), vascular, paravalvular leak, in-hospital mortality, others] was calculated for TAVR patients at a high-volume center between 2012 and 2018. Clinical data were matched with hospital-billing data of patients. Trends in high resource utilization (discharge to a rehabilitation facility or PLOS7 days) (HRU) and complication rates were assessed. Multivariable logistic regression models were used to determine predictors of HRU.Out of 1163 patients, 966 (83%) had no complications, others in 95 (8%), PPM in 56 (5%), AKI alone in 32 (3%), vascular in 31 (3%), in-hospital mortality in 28 (2%) and PVL in 10 (1%). A significant decreasing trend in the incidence of complications (29% vs 10%; p trend0.001) and HRU (75% vs 12%; p trend0.001) was observed between 2012 and 2018 respectively. Mean ± SD direct procedure cost of having a complication was $58,234 ± $24,568, was associated with an incremental cost of $10, 649 and a prolonged stay of 3-days. On multivariable logistic regression analysis, PPM, vascular complications, high STS risk score, NYHA class III/IV, frailty and ≥ moderate tricuspid regurgitation were significantly associated with HRU. TAVR year was protective against HRU.We established that, post-TAVR resource utilization and morbidity is high among frail and patients with higher STS risk scores. However, these rates decrease over time with experience.

The study aims to investigate the incidence of immediate renal function improvement in renal dysfunction patients who had transcatheter aortic valve implantation (TAVI). TAVI patients with ≥ moderate reduced renal function [estimated GFR ≤ 60 ml/min/1.73 m2] at baseline were identified from a prospectively maintained database. Patients were divided into 3 groups based on percent change [(discharge eGFR − baseline eGFR/baseline GFR) × 100] in eGFR post-TAVR. Improvement ≥ 10%, no change, Decline ≥ 10%. Multivariable logistic regression was performed to identify factors that predicted improvement/decline in GFR postprocedure. Out of 677 patients, 359 (53%) had eGFR ≤ 60 ml/min/1.73 m2. Of these, 188 (52%) had an improvement in eGFR ≥ 10%, 125 (34%) had no change and 48 (14%) observed decline ≥ 10%. All groups had similar proportions of females and age was comparable in patient groups. Patients in whom a decline in eGFR was observed had significantly higher Society of thoracic Surgeons scores (10.7 vs 8.2 vs 8.2; p = 0.007) and incidence of liver disease (6% vs, 0% vs 2%; p = 0.014) than the no-change or improved groups respectively. On multivariable analysis, independent predictors of decline/improvement in eGFR were being female, low left ventricular ejection fraction and baseline liver dysfunction. In conclusion, over half of patients with compromised renal function who underwent TAVI experience an immediate improvement in kidney function post-TAVI. Being female, baseline liver dysfunction and a low left ventricular ejection fraction is associated with an immediate decline in eGFR.

ObjectivesOur aim was to compare available transcatheter aortic valve replacement (TAVR) valves using direct and indirect evidence from randomized controlled trials (RCT).BackgroundTAVR is now an established treatment for majority of patients with severe aortic stenosis. However, there is limited data comparing various valves.MethodsWe performed a systematic search of electronic databases for RCT comparing a TAVR valve to a valve or surgery. A Bayesian network meta-analysis was performed to compile evidence from both direct and indirect comparisons at 30 days and at one year.ResultsTwelve studies with 10,307 patients eligible for TAVR met the criteria and were included. Self-expanding valve CoreValve type (SEV_C) is associated with higher risk of pacemaker implantation and use of >1 valve, SEV Accurate type (SEV_A) is associated with higher risk of ≥ moderate aortic regurgitation (AR) and death, and mechanically expandable valve (MEV) is associated with lower risk of ≥ moderate AR but higher risk of pacemaker at 30 days, SEV_C and MEV were associated with higher pacemaker rates compared balloon expandable valve (BEV) at 1 year. There is no difference among the valves in stroke at 30 days and 1 year.ConclusionsAt 30 days, BEV was superior on one or more outcomes of mortality, pacemaker implantation, >1 valve implantation, and ≥ moderate AR compared to other valves except the higher rate ≥?moderate AR compared to MEV. At one year, BEV was associated with lower odds of pacemaker implantation compared to SEV_C and MEV but not different on other end points.

The purpose of this study is to assess the impact of frailty index comprised of commonly used frailty metrics on outcomes following transcatheter aortic valve replacement (TAVR) outcomes, including mortality, length of stay, and discharge destination.Retrospective data collection was performed for 342 consecutive patients who underwent TAVR at a single center from May 15, 2012, to September 17, 2015. Frailty index score was calculated using 15-ft walk test, Katz activities of daily living, preoperative serum albumin, and dominant handgrip strength. Patients were given a frailty score from 0/4 to 4/4, with higher scores indicating greater levels of frailty. There were 27 patients (8%) in 0/4, 82 patients (24%) in 1/4, 129 patients (38%) in 2/4, 73 patients (21%) in 3/4, and 31 patients (9%) in 4/4 frailty group. Multivariate cox, logistic, and linear regression analyses showed that patients with frailty score of 3/4 or 4/4 had increased all-cause mortality (P = .015 and P.001) and were more likely to be discharged to an acute care facility (P = .083 and P = .001). 4/4 frail patients had increased post-operative length of stay (P = .014) when compared to less frail patients. Individual components of the frailty score were also independent predictors of all-cause mortality. Median survival in 4/4 frail patients was 7 months.Frailty index comprised of commonly used frailty metrics and its components are independent predictors of poor post-TAVR outcomes. There is a stepwise increase in mortality and post-TAVR length of stay with increasing frailty with dismal prognosis in extremely frail patients.

This study sought to determine predictors of advanced conduction disturbances requiring late (≥ 30-days) permanent pacemaker implantation (PPI) after transcatheter aortic valve replacement (TAVR). A prospectively maintained TAVR database was queried to identify all patients who had TAVR at a high

RAASi use is common in patients with AS and has some, albeit inconsistent, evidence of contrast-induced nephropathy reduction. We aimed to investigate the effects of RAAS agents on post-operative AKI in aging patients undergoing TAVR. Patients who had TAVR at a single center were retrospectively

Previous studies have identified polypharmacy as a potential risk factor for hospital readmission. We aimed to assess the overall impact of the number of discharge medications on hospital readmission after transcatheter aortic valve replacement (TAVR). The number of discharge medications of

When untreated, Aortic stenosis (AS) patients with renal dysfunction report dismal prognosis. The study aims to investigate operative outcomes in renal dysfunction patients who had transcatheter aortic valve replacement. (TAVR) TAVR patients with ≥ moderately reduced renal function [estimated

Valve-in-valve transcatheter aortic valve replacement (VIV TAVR) can result in high residual gradients that are associated with increased mortality. Bioprosthetic valve fracture (BVF) has been shown to improve residual gradients following VIV TAVR; however, factors influencing the results of BVF have not been studied.BVF was performed in 75 patients at 21 centers. Hierarchical multiple linear regression was performed to identify variables that were associated with lower final transvalvular gradient.Surgical valves with a median true internal diameter of 18.5 mm (interquartile range, 17.0-20.5 mm) were treated with VIV TAVR in conjunction with BVF using balloon-expandable (n = 43) or self-expanding (n = 32) transcatheter heart valves with a median size of 23 mm (interquartile range, 23-23 mm). There were no aortic root disruptions, coronary occlusions, or new pacemakers; in-hospital or 30-day mortality was 2.6% (2 out of 75). Final mean transvalvular gradient was 9.2 ± 6.3 mm Hg, but was significantly lower when BVF was performed after VIV TAVR compared with BVF first (8.1 ± 4.8 mm Hg vs 16.9 ± 10.1 mm Hg; P .001). After adjusting for timing of BVF (ie, before or after VIV TAVR), transcatheter heart valve size/type, surgical valve mode of failure, true internal diameter, and baseline gradient and BVF balloon size, performing BVF after VIV TAVR (P .001) and using a larger BVF balloon (P = .038) were the only independent predictors of lower final mean gradient.BVF can be performed safely and results in reduced residual transvalvular gradients. Performing BVF after VIV TAVR and using larger balloon appears to achieve the best hemodynamic results.

The present study aimed to determine (i) the effect of post-transcatheter aortic valve replacement (TAVR) complications rates (CR) on direct procedure costs and resource utilization (RU) and (ii) impact of operator experience on trends in CR and RU. Clinical data were matched with hospital-billing

Patients undergoing transcatheter aortic valve replacement (TAVR) are likely to be discharged to a location other than home. We aimed to determine the association between preoperative risk factors and non-home discharge. Patients admitted from home and discharged alive after TAVR at a single center

Recent advances in transcatheter aortic valve replacement (TAVR) have led to the adoption of the technology in patients with lower surgical risk. The present study aims to analyze direct costs associated with TAVR in patients with different pre-operative risks. Data were drawn from a prospectively

Background: With high resolution live 3-D TEE and 4-D dynamic cardiac CT, anatomic aortic valve area can be directly traced without geometric assumptions and flow calculations. We hypothesize that direct planimetry of AVA either by 3-D TEE or cardiac CT provides a reliable measurement of anatomic