Sex-related differences in clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic stenosis

Introduction: There are inconsistent data on the sex-related differences in clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). Aim: We sought to investigate sex-related differences in procedural, clinical and QoL outcomes of TAVI. Material and methods: A total of 101 consecutive patients undergoing TAVI were enrolled. Patients were stratified by gender. Baseline characteristics, procedural and long-term clinical outcomes as well as frailty and QoL indices (EQ-5D-3L questionnaire) were compared between women and men. Results: Women represented 60.4% of the study population. Periprocedural risk measured with the Logistic EuroSCORE and STS scale was similar for women and men. There were no differences in 30-day or 12-month all-cause mortality between groups (women vs. men: 9.8% vs. 12.5%; age-adjusted odds ratio (OR) (95% CI): 1.38 (0.39–4.94); 13.1% vs. 25.0%; age-adjusted OR (95% CI): 2.51 (0.87–7.25)). Men were at higher risk of new onset atrial fibrillation at follow-up (1.6% vs. 17.5%; age-adjusted OR (95% CI): 14.61 (1.68–127.37)). In multivariable Cox regression analysis, a history of stroke/transient ischemic attack (TIA) (hazard ratio (HR)) (95% CI): 3.93 (1.39–11.07) and blood transfusion (HR (95% CI): 2.84 (1.06–7.63)) were identified as independent factors affecting 12-month mortality. No differences in QoL parameters were noted. Conclusions: The TAVI can be considered as an effective and safe treatment in high-risk patients with severe aortic stenosis, regardless of gender

Wpływ przebytej operacji kardiochirurgicznej z sternotomią na wyniki kliniczne i jakość życia pacjentów po przezskórnej implantacji zastawki aortalnej

Background: Transcatheter aortic valve implantation (TAVI) has evolved as an effective treatment in patients with symptomatic severe aortic stenosis (AS) and increased operative risk. Data on the influence of previous sternotomy on the risk of TAVI are limited. Aim: We sought to investigate the effect of previous cardiac surgery with sternotomy on clinical outcomes and quality of life (QoL) after TAVI. Methods: The study included 148 consecutive patients with symptomatic severe AS, who underwent TAVI. Baseline charac-teristics, procedural and long-term clinical outcomes, and QoL assessment with the EQ-5D-3L questionnaire were compared between patients with and without previous sternotomy. Results: Patients with previous sternotomy (23.0% of the population) were younger and more often male, had higher rate of previous myocardial infarction (MI; 26 [22.8%] vs. 22 [64.7%], p = 0.001), and lower median left ventricular ejection frac-tion (60.0% [50.0–65.0] vs. 50.0% [42.0–60.0], p = 0.004). Periprocedural risk measured with the Logistic Euroscore and the Society of Thoracic Surgeons scale was comparable in both groups. There were no differences in 30-day and 12-month all-cause mortality between the groups with and without sternotomy (10 [8.8%] vs. 2 [5.9%], p = 0.7; odds ratio [OR] adjusted for age/sex/previous MI, 0.56, 95% confidence interval [CI] 0.10–3.29; for 12-month mortality adjusted OR 0.19, 95% CI 0.04–0.99). At the longest available follow-up, mortality was higher in patients without sternotomy (30 [26.3%] vs. 3 [8.8%], p = 0.03; adjusted OR 0.10, 95% CI 0.02–0.42). Similar rates of other complications after TAVI were noted. No differences in the EQ-5D-3L questionnaire at baseline and 12-month follow-up were confirmed. Conclusions: TAVI seems to be a safe and effective technique for the treatment of severe AS in patients with previous cardiac surgery.Wstęp: Przezskórna implantacja zastawki aortalnej jest skuteczną metodą leczenia pacjentów z wysokim ryzykiem operacyjnym i ciężkim objawowym zwężeniem zastawki aortalnej. Wpływ przebytej w przeszłości sternotomii na ryzyko przezskórnej implantacji zastawki aortalnej nie jest dokładnie zbadany. Cel: Celem pracy była ocena wpływu przebytej operacji kardiochirurgicznej z sternotomią na wyniki kliniczne i jakość życia u pacjentów poddawanych przezskórnej implantacji zastawki aortalnej. Metody: Do badania zostało włączonych 148 kolejnych pacjentów z ciężkim objawowym zwężeniem zastawki aortalnej zakwalifikowanych do przezskórnej implantacji zastawki aortalnej. Dane kliniczne, zabiegowe i długoterminowa obserwacja wraz z oceną jakości życia przy użyciu kwestionariusza EQ-5D-3L zostały porównane między pacjentami w zależności od przebytej w przeszłości operacji kardiochirurgicznej z sternotomią. Wyniki: Pacjenci z wywiadem sternotomii stanowili 23% całej populacji badania. Pacjenci po przebytej sternotomii byli młodsi, częściej byli mężczyznami. W tej grupie odnotowano większą częstość przebytego w przeszłości zawału serca [26 (22,8%) vs. 22 (64,7%), p = 0,001] oraz niższą frakcję wyrzutową lewej komory [60,0 (50,0–65,0) vs. 50,0 (42,0–60,0) [%], p = 0,004]. Ryzyko okołozabiegowe ocenione za pomocą Logistic Euroscore oraz skali STS było porównywalne w obu grupach. Nie zaobserwowano różnic między grupami w zakresie śmiertelności podczas 30-dniowej i 12-miesięcznej obserwacji [sternotomia(–) vs. sternotomia(+): 10 (8,8%) vs. 2 (5,9%); p = 0,7, korekta względem wieku/płci/przebytego zawału serca: OR 0,56; 95% CI 0,10–3,29; dla 12-miesięcznej obserwacji po korekcie OR: 0,19; 95% CI 0,04–0,99)]. Śmiertelność w najdłuższym dostępnym okresie obserwacji była wyższa w grupie pacjentów po przebytej w przeszłości sternotmii [30 (26,3%) vs. 3 (8,8%); p = 0,03, korekta względem wieku/płci/przebytego zawału serca: OR 0,10; 95% CI 0,02–0,42]. Częstość powikłań i jakość życia po przezskórnej implantacji zastawki aortalnej była porównywalna w obu grupach pacjentów. Wnioski: Przezskórna implantacja zastawki aortalnej jest bezpieczną i efektywną metodą leczenia pacjentów z ciężkim objawowym zwężeniem zastawki aortalnej i wywiadem przebytej w przeszłości operacji kardiochirurgicznej ze sternotomią

Effect of diabetes mellitus on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic valve stenosis

Background: Diabetes mellitus (DM) is considered a marker of poor prognosis after cardiac surgery. We sought to investigate the effect of DM on clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). Methods: A total of 148 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVI were included. Baseline characteristics, procedural and long-term clinical outcomes, and the results of frailty and QoL assessment with EQ-5D-3L questionnaire were compared between patients with and without DM. Results: DM was present in 48 of 148 (32.4%) patients. No differences in periprocedural risk (Logistic Euroscore and Society of Thoracic Surgeons (STS) scale) between groups were observed. There were no differences in 30-day and 12-month all-cause mortality between groups [DM(−) vs. DM(+): 7 (7.0%) vs. 5 (10.4%), p = 0.53 and 12 (12.0%) vs. 10 (20.8%), p = 0.16, respectively]. No influence of DM presence on the risk of death was confirmed after adjustment for age and gender (for 30-day mortality, age/gender-adjusted OR 1.55, 95%CI 0.47–5.17; for 12-month mortality, age/gender-adjusted OR 2.05, 95%CI 0.79–5.32). Similarly, at the longest available follow-up, mortality did not differ between groups [14 (29.2%) vs. 19 (19.0%), p = 0.16; age/gender-adjusted OR 1.81, 95%CI 0.80–4.08]. Similar rates of other complications after TAVI were noted. Frailty measured with the 5-meter walking test was more frequently reported in patients with DM [11 (22.9%) vs. 10 (10.0%), p = 0.035]. No differences in QoL parameters at baseline and 12 months were noted. Conclusions: Patients with DM undergoing TAVI demonstrated similar mortality, complication rates, and QoL outcomes compared to patients without DM. Keywords: Frailty, Transcatheter aortic valve replacement, Aortic valve disease, High-risk patients, Registr

Early- and mid-term outcomes after transcatheter aortic valve implantation. Data from a single-center registry

Introduction : Transcatheter aortic valve implantation (TAVI) is a less invasive treatment option for elderly, high-risk patients with symptomatic severe aortic stenosis (AS) than aortic valve replacement. More importantly, TAVI improves survival and quality of life as compared to medical treatment in inoperable patients. Aim: To assess early- and mid-term clinical outcomes after TAVI. Material and methods: All consecutive high-risk patients with severe symptomatic AS undergoing TAVI from November 2008 to August 2014 were enrolled. The clinical and procedural characteristics, as well as clinical outcomes including mortality during 12-month follow-up, were assessed. Results : A total of 101 consecutive patients underwent TAVI for native aortic valve stenosis (100%). Patients were elderly, with a median age of 81.0 (76.0–84.0) years, 60.4% were female and 83.2% presented with NYHA III/IV. Median baseline EuroSCORE I and STS scores were 14.0 (10.0–22.5)% and 12.0 (5.0–24.0)%, respectively. The main periprocedural and in-hospital complications were minor vascular complications, bleeding requiring blood transfusions, and the need for a permanent pacemaker. In-hospital, 30-day, 6-month and 12-month mortality rates were 6.9%, 10.9%, 15.8% and 17.8%, respectively. Conclusions : A mortality rate of < 20% after 12 months seems acceptable given the high-risk population enrolled