Program/Abstract #110 will be presented as scheduled, but the abstract cannot be published due to lack of license agreement between authors and publisher.

Background Since it was anticipated that the need for doctors would increase due to demographic changes, the number of positions for medical specialty training programs has increased from the year 2000 onwards. However, the number of permanent positions for young cardiologists did not follow that trend leading to concerns about future employment. Therefore, the aim of the current study was to assess short-term career perspectives of young cardiologists in the Netherlands. Methods All cardiologists who ended their training between 1 January 2011 and 31 December 2014 were invited to fill in a questionnaire about their first employment status and were followed yearly until the participant had a permanent position. The timespan between the end of training and the moment of permanent employment was assessed. Furthermore, the association between professional profile and short-term career perspectives was investigated. Results The observed unemployment was 1.6% and lasted less than a year in all cases. Of the participants, 77% started their career with a temporary contract; within four years this was 7%. Of young cardiologists, 46% started their career as a fellow and 24% as an attending physician. A total of 29% of male cardiologists started their career with a permanent contract as compared with 12% of females (p = 0.01). Within two years this difference was no longer observed. Conclusions Unemployment is low among young cardiologists. Most cardiologists start their career with a temporary contract. The time to a permanent contract is slightly longer for female cardiologists as compared with males

Incidence, determinants and consequences of delirium in older patients after transcatheter aortic valve implantation

Background: delirium is an event leading to negative health outcomes and increased mortality in patients. The aim of this study is to investigate the incidence, determinants and consequences of post-operative delirium (POD) in older patients undergoing transcatheter aortic valve implantation (TAVI). Methods: The TAVI Care and Cure program is a prospective, observational registry in patients referred for TAVI at Erasmus University Medical Centre. The presence of delirium was evaluated by daily clinical assessment by a geriatrician pre- and up to 3 days post-TAVI. Mortality data were obtained from the Dutch Civil Registry. Results: A total of 543 patients underwent TAVI between January 2014 and December 2017. Overall, the incidence of POD was 14% (75/543 patients) but declined from 18% in 2014 to 7% in 2017 (P = 0.009). Patients who developed POD were older (81.9 ± 5.8 versus 78.6 ± 8.3 years, P < 0.001), had higher prevalence of renal dysfunction and prior stroke (54% versus 40%, P = 0.02; 31% versus 18%, P = 0.01) and were more often frail (32% versus 25%, P = 0.02). From a procedural perspective, general anesthesia (odds ratios (OR), 2.31; 95% CI, 1.40–3.83; P = 0.001), non-transfemoral access (OR, 2.37; 95% CI, 1.20–4.70; P = 0.01) and longer procedural time (OR, 1.01; 95% CI, 1.01–1.02; P < 0.001) were significantly associated with POD. One-year survival rate was 68% among patients who had suffered a POD and was 85% in patients without a POD (hazard ratio’s 1.8 (95% CI 1.01–3.10), P = 0.045). Conclusion: POD frequently occurs after TAVI and is associated with increased mortality. It might be speculated that patient selection and the minimalistic approach of TAVI may reduce the frequency of delirium

Defective recovery of QT dispersion following transcatheter aortic valve implantation: Frequency, predictors and prognosis

Background: Corrected QT dispersion (cQTD) has been correlated with non-uniform ventricular repolarisation and increased mortality. In patients with aortic stenosis, cQTD has been shown improved after surgical valve replacement, but the effects of transcatheter aortic valve implantation (TAVI) are unknown. Therefore, we sought to explore the frequency, predictors and prognostic effects of defective cQTD recovery at 6 months after TAVI. Methods: A total of 222 patients underwent TAVI with the Medtronic-CoreValve System between November 2005 and January 2012. Patients who were on class I or III antiarrhythmics or on chronic haemodialysis or who developed atrial fibrillation, a new bundle branch block or became pacemaker dependent after TAVI were excluded. As a result, pre-, post- and follow-up ECG (median: 6 months) analysis was available in 45 eligible patients. Defective cQTD recovery was defined as any progression beyond the baseline cQTD at 6 months. Results: In the 45 patients, the mean cQTD was 47 ± 23 ms at baseline, 45 ± 17 ms immediately after TAVI and 40 ± 16 ms at 6 months (15% reduction, P = 0.049). Compared to baseline, cQTD at 6 months was improved in 60% of the patients whereas defective cQTD recovery was present in 40%. cQTD increase immediately after TAVI was an independent predictor of defective cQTD recovery at 6 months (per 10 ms increase; OR: 1.89, 95% CI: 1.15-3.12). By univariable analysis, defective cQTD recovery was associated with late mortality (HR: 1.52, 95% CI: 1.05-2.17). Conclusions: Despite a gradual reduction of cQTD after TAVI, 40% of the patients had defective recovery at 6 months which was associated with late mortality. More detailed ECG analysis after TAVI may

Artificial Intelligence and Transcatheter Interventions for Structural Heart Disease: A glance at the (near) future

With innovations in therapeutic technologies and changes in population demographics, transcatheter interventions for structural heart disease have become the preferred treatment and will keep growing. Yet, a thorough clinical selection and efficient pathway from diagnosis to treatment and follow-up are mandatory. In this review we reflect on how artificial intelligence may help to improve patient selection, pre-procedural planning, procedure execution and follow-up so to establish efficient and high quality health care in an increasing number of patients

Impact of frailty on health-related quality of life 1 year after transcatheter aortic valve implantation

Background: Transcatheter aortic valve implantation (TAVI) brings symptom relief and improvement in health-related quality of life (HRQoL) in the majority of patients treated for symptomatic, severe aortic stenosis. However, there is a substantial group of patients that do not benefit from TAVI. The aim of this study is to investigate the impact of frailty on HRQoL 1 year after TAVI. Methods: The TAVI Care & Cure Program is an ongoing, prospective, observational study including patients referred for TAVI to our institution. A comprehensive geriatric assessment was performed to evaluate existence of frailty using the Erasmus Frailty Score (EFS). HRQoL was assessed using the EQ-5D-5 L at baseline and 1 year after TAVI. Results: 239 patients underwent TAVI and completed HRQoL assessment 1 year after TAVI. Seventy (29.3%) patients were classified as frail (EFS ≥ 3). In non-frail patients, the EQ-5D-5 L index did not change (0.71(± 0.22) to 0.68(± 0.33) points, P = 0.22); in frail patients, the EQ-5D-5 L index decreased from 0.55(±0.26) to 0.44 points (±0.33) (P = 0.022). Frailty was an independent predictor of deteriorated HRQoL 1 year after TAVI (OR 2.24, 95% CI 1.07–4.70, P = 0.003). In frail patients, the absence of peripheral artery disease (OR 0.17, 95% 0.05–0.50, P = 0.001) and renal dysfunction (OR 0.13, 95% CI 0.04–0.41, P = <0.001) at baseline was associated with improved HRQoL 1 year after TAVI. Conclusion: Frailty is associated with deterioration of HRQoL 1 year after TAVI. Notably, HRQoL did improve in frail patients with no peripheral arterial disease or renal impairment at baseline

Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement

BACKGROUND: In aortic stenosis, valvulo-arterial impedance (Zva) estimates the overall left ventricular afterload (valve and arterial component). We investigated the association of Zva (≥5 versus <5 mm Hg mL-1 m-2) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR). METHODS: The study population consists of 250 TAVR patients in whom baseline Zva and follow-up QOL was prospectively assessed using EuroQOL-5-dimensions instruments; EP was assessed in 192 patients who survived ≥1 year after TAVR using questionnaires related to daily activities. In 124 patients, Zva at 1-year was also available and was used to study the change in Zva (baseline to 1 year) on QOL/EP. RESULTS: Elevated baseline Zva was present in 125 patients (50%). At a median of 28 (IQR, 17-40) months, patients with elevated baseline Zva were more limited in mobility (88% versus 71%; P=0.004), self-care (40% versus 25%; P=0.019), and independent daily activities (taking a shower: 53% versus 38%, P=0.030; walking 100 meter: 76% versus 54%, P=0.001; and walking stairs: 74% versus 54%, P=0.011). By multivariable analysis, elevated Zva predicted unfavorable QOL (lower EuroQOL-5-dimensions-Utility Index, odds ratio, 1.98; CI, 1.15-3.41) and unfavorable EP (any limitation in ≥3 daily activities, odds ratio, 2.55; CI, 1.41-4.62). After TAVR, the proportion of patients with elevated Zva fell from 50% to 21% and remained 21% at 1 year and was found to be associated with more limitations in mobility, self-care, and daily activities compared with patients with Zva <5 mm Hg mL-1 m-2. CONCLUSIONS: Elevated Zva was seen in half of patients and predicted unfavorable long-term QOL and EP. At 1 year after TAVR, the prevalence of elevated Zva was 21% but remained associated with poor QOL/EP

How should I treat a staggering TAVI procedure?

Background: A 79-year-old female patient with past medical history of chronic myeloid leukaemia, presented to the outpatient cardiology clinic with shortness of breath (NYHA class 3) and fatigue. Investigation: Echocardiography (ECG) and multislice computed tomography (MSCT). Diagnosis: Severe calcified aortic valve stenosis by echocardiography. Logistic EuroSCORE 10.3. Porcelain aorta by multislice computed tomography (MSCT). Treatment: Transcatheter aortic valve implantation (TAVI) with an 18 Fr Medtronic-CoreValve system (Medtronic Inc., Minneapolis, MN, USA) using a right transfemoral arterial approach

Prevalence and prognostic implications of baseline anaemia in patients undergoing transcatheter aortic valve implantation

Aims: TAVI is a minimally invasive alternative to surgical aortic valve replacement or medical therapy in patients with a high or prohibitive operative risk. The clinical significance of baseline anemia and prognostic implications in this patient cohort are unknown. We sought to evaluate the prevalence and prognostic implications of baseline anaemia in patients undergoing transcatheter aortic valve implantation (TAVI) at our institution. Methods and results: One hundred and eighteen consecutive patients who underwent TAVI with the Medtronic Corevalve System (Medtronic Corp., Minneapolis, MN, USA) were included in the analysis. Clinical and biochemical data were prospectively collected before, during and after the procedure. Clinical follow-up was set at one month, one year and yearly thereafter. Anaemia was defined as a haemoglobin level <13 g/dL in men and <12 g/dL in women. Mortality was confirmed by consultation of the civil registry. The prevalence of baseline anaemia was 49%. Anaemic patients undergoing TAVI required more RBC transfusions (3.3±3.1 versus 1.5±2.3; p <0.001) and more frequently experienced a prolonged index hospitalisation exceeding two weeks. For patients with at least 1-year follow up (N=74), mortality at 30 days was no different; however 1-year mortality was significantly higher in the anaemic cohort (44 versus 15%, p=0.006). In a multivariable analysis, baseline anaemia emerged as an independent predictor of 1-year mortality (HR 2.10 [1.06-4.18]). Conclusions: In our series, baseline anaemia is common in patients undergoing TAVI, forecasts a need for more red blood cell transfusions and is associated with increased 1-year mortality