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Background. The significance of concomitant tricuspid regurgitation (TR) in the context of transcatheter aortic valve replacement (TAVR) remains unclear. This study aimed to analyze the severity of TR before and after TAVR with regard to short- and long-term survival and to analyze the influencing factors. Methods. In our retrospective analysis, TR before and after TAVR was examined and patients were classified into groups accordingly. Special attention was paid to patients with post-interventional changes in TR. Mortality after TAVR was considered the primary endpoint of the analysis and major complications according to the Valve Academic Research Consortium 3 (VARC3) were compared. Moreover, biomarkers and risk factors for worsening or improvement of TR through TAVR were analyzed. Results. Among 775 patients who underwent TAVR in our center between January 2009 and December 2019, 686 patients (89%) featured low- and 89 patients (11%) high-grade TR. High-grade pre-TAVR TR was associated with worse short- (30-day), mid- (2-year) and long-term survival up to 8 years. Even though in nearly half of the patients with high-grade TR the regurgitation improved within seven days after TAVR (n = 42/89), this did not result in a survival benefit for this subgroup. On the other hand, a worsening of low-grade TR was seen in more than 10% of the patients (n = 73/686), which was also associated with a worse prognosis. Predictors of worsening of TR after TAVR were adipositas, impaired right ventricular function and the presence of mild TR. Age, atrial fibrillation, COPD, impaired renal function and elevated cardiac biomarkers were risk factors for mortality after TAVR independent from the grade of TR. Conclusions. Not only pre-interventional, but also post-TAVR high-grade TR is associated with a worse prognosis after TAVR. TAVR can change concomitant tricuspid regurgitation, but improvement does not have any impact on short- and long-term survival. Worsening of TR after TAVR is possible and impairs the prognosis. [ABSTRACT FROM AUTHOR]

Aim Risk assessment of patients undergoing transcatheter aortic valve implantation ( TAVI) remains difficult. Biomarkers have been shown to provide potential prognostic information . Here, we aimed to analyze whether the biomarker high-sensitivity Troponin T (hs TNT) could be used to improve risk stratification. Method We prospectively enrolled 267 patients undergoing TAVI. Biomarkers (hs TNT and NTpro BNP) were measured 1 day before, and 3 and 7 days postprocedure. All possible prognostic factors upon survival time were analyzed by Cox regression analysis. Results A total of 259 patients (mean age 82±6.1 years) were available for complete follow-up. The median Logistic Euro SCORE (Log ES) and Log ES II were 21.16% (Q1=13.92; Q3=34.27) and 6.42% (Q1=3.89; Q3=11.07), respectively. Median follow-up was 290 (Q1=88; Q3=529) days. A total of 71 deaths occurred during follow-up, and the 30-day mortality was 5.8%. Median baseline hs TNT was 27.4 pg/mL (Q1=16.2; Q3=46 pg/mL). From all potential mortality-associated factors, only preprocedural hs TNT level ( P=.001), elevated Log ES ( P=.03) as well as acute kidney injury ( P<.001) and chronic obstructive pulmonary disease ( COPD) ( P=.039) emerged as independent prognostic parameters for adverse outcome. We also tested whether the Valve Academic Research Consortium-2 ( VARC- II) cutoff for myocardial damage (hs TNT peak value exceeding 15× the upper reference limit + at least 50% increase) was of prognostic relevance. At 72-hours post- TAVI, 36.2% of the patients matched these VARC- II criteria of myocardial damage. However, these patients did not display a difference in survival compared to patients without significant myocardial injury. Conclusion Elevated preprocedural hs TNT represents an independent risk predictor of all-cause death while periprocedural hs TNT elevation failed to show prognostic relevance. [ABSTRACT FROM AUTHOR]

Aims: Transcatheter aortic valve implantation (TAVI) has emerged as a treatment of aortic stenosis in patients at high surgical risk. However, risk stratification in this elderly population is challenging, as patients at extreme risk might not benefit from TAVI. While several clinical criteria have been proposed for estimating the outcome, prediction of individual risk remains difficult. Therefore, our aim was to assess the prognostic value of the biomarker growth differentiation factor 15 (GDF15).Methods and Results: Over a 2.9-year period, we prospectively enrolled 217 patients undergoing TAVI. Clinical parameters, risk scores, and biomarkers (NT-proBNP and GDF15) were measured at baseline. The primary endpoint was survival time; prognostic factors were analysed by Cox regression analysis. Mean age of study participants was 81.8 ± 6.0 years. Median Logistic EuroSCORE was 20.1 (Q1-Q3 13.6-32.6). Thirty-day mortality was 6.9%; 30.4% of the patients died during follow-up [median 349 days (Q1-Q3 106-660)]. Median pre-procedural GDF15 values were 2256 pg/mL (1585-3082). High GDF15 levels were associated with numerous factors that could contribute to poor outcome. Analyses comparing the upper quartile with the lower three quartiles for biomarker levels revealed a hazard ratio (HR) of increased GDF15 for adverse outcome of 2.4 [95% confidence interval (CI) 1.5-3.9, P < 0.001]. Of note, in multiple analyses, elevated GDF15 levels were superior to NT-proBNP for predicting negative outcome (adjusted HR of GDF15 1.97, 95% CI 1.2-3.3; P = 0.009).Conclusion: Elevated GDF15 levels were superior to NT-proBNP for TAVI risk stratification and provided additional prognostic information. Thus, patient selection for TAVI may benefit from measurement of GDF15. [ABSTRACT FROM AUTHOR]

Objectives: The current 2017 ESC/EACTS guidelines recommend transcatheter aortic valve implantations (TAVIs) as the therapy of choice for inoperable patients with severe symptomatic aortic stenosis. Most of the TAVIs worldwide are performed under general anaesthesia (GA). Although conscious sedation (CS) concepts are increasingly applied in Europe, it is still a matter of debate which concept is associated with highest amount of safety for this high‐risk patient population. The aim of this single center, before‐and‐after study was to investigate feasibility and safety of CS compared with GA with respect to peri‐procedural complications and 30‐day mortality in patients scheduled for transfemoral TAVI (TF‐TAVI). Methods: From March 2012 until September 2014, patients scheduled for the TF‐TAVI procedure were included in a prospective, observational manner. From the 200 patients finally included, 107 procedures were performed under GA, using either an endotracheal tube or a laryngeal mask, and balanced anaesthesia. CS was performed in 93 patients using low‐dose propofol and remifentanil. Results: Conversion to GA was needed 4 times due to procedural‐related complications (4.3%), in one patient due to ongoing agitation (1.1%). The CS‐group showed significantly shorter key time courses: anaesthesia time (105 [95‐120] minutes vs 115 [105‐140] minutes, P‐value = 0.009, Mann‐Whitney‐U‐test) and length of stay in the intensive care unit (1.6 [1.0‐1.5] d vs 2.1 [1.0‐2.0] d, P‐value = 0.002, Mann‐Whitney‐U‐test). The lowest mean arterial pressure was significantly higher in the CS‐group compared with the GA‐group (74.3 mmHg vs 55.2 mmHg, P‐value <0.0001, t‐test). CS was associated with less requirements of norepinephrine (0.1 μg/kg vs 2.3 μg/kg, P‐value <0.0001, Mann‐Whitney‐U‐test). Conclusions: Our single‐center data demonstrate that CS is a feasible and safe alternative, especially with respect to a higher degree of intra‐procedural haemodynamic stability, and a reduced length of stay in the intensive care unit. [ABSTRACT FROM AUTHOR]