Outcome prediction following transcatheter aortic valve implantation: Multiple risk scores comparison

Background: The aim of the study was to compare 7 available risk models in the prediction of 30-day mortality following transcatheter aortic valve implantation (TAVI). Heart team decision supported by different risk score calculations is advisable to estimate the individual procedural risk before TAVI. Methods: One hundred and fifty-six consecutive patients (n = 156, 48% female, mean age 80.03 ± 8.18 years) who underwent TAVI between March 2010 and October 2014 were in­cluded in the study. Thirty-day follow-up was performed and available in each patient. Base­line risk was calculated according to EuroSCORE I, EuroSCORE II, STS, ACEF, Ambler’s, OBSERVANT and SURTAVI scores. Results: In receiver operating characteristics analysis, neither of the investigated scales was able to distinguish between patients with or without an endpoint with areas under the curve (AUC) not exceeding 0.6, as follows: EuroSCORE I, AUC 0.55; 95% confidence intervals (CI) 0.47–0.63, p = 0.59; EuroSCORE II, AUC 0.59; 95% CI 0.51–0.67, p = 0.23; STS, AUC 0.55; 95% CI 0.47–0.63, p = 0.52; ACEF, AUC 0.54; 95% CI 0.46–0.62, p = 0.69; Ambler’s, AUC 0.54; 95% CI 0.46–0.62, p = 0.70; OBSERVANT, AUC 0.597; 95% CI 0.52–0.67, p = 0.21; SURTAVI, AUC 0.535; 95% CI 0.45–0.62, p = 0.65. SURTAVI model was calibrated best in high-risk patients showing coherence between expected and observed mortality (10.8% vs. 9.4%, p = 0.982). ACEF demonstrated best classification accuracy (17.5% vs. 6.9%, p = 0.053, observed mortality in high vs. non-high-risk cohort, respectively). Conclusions: None of the investigated risk scales proved to be optimal in predicting 30-day mortality in unselected, real-life population with aortic stenosis referred to TAVI. This data supports primary role of heart team in decision process of selecting patients for TAVI

Attempt at application of the International Classification of Functioning, Disability and Health (ICF) in the domains of body and structure function and activity and participation in the assessment of the rate of disability in patients with morbid obesity : pilot study

Background. Due to the constant increase in the number of morbidly obese patients, an adequate tool for assessing the functioning and disability of these patients is being sought. The International Classification of Functioning, Disability and Health (IC F) could be that tool. Objectives. The aim of this study is to examine the usefulness of the IC F scale in assessing the functioning of morbidly obese patients in two selected areas in reference to recognized scales. Material and methods . The study group included 76 patients with morbid obesity qualified for bariatric treatment. The ICF was applied to assess the function and limitations of each individual. Two domains of the IC F were selected: Body Functions and Structures and Activities and Participation. The usefulness of the IC F was compared to that of the Barthel and EPQ-R scales. Results . In morbidly obese patients, a correlation between motor functions and IC F and BMI, as well as age, was observed. A significant correlation was observed between BMI and psychomotor control, appropriateness and range of emotions experienced, age and amount of sleep, quality of sleep, memory retrieval and psychomotor functions. Women’s mental functions were significantly worse than those of men. In terms of interpersonal relations, a correlation between BMI and regulating behavior within interactions was observed. Conclusions . The IC F is a useful tool for the study and description of the functioning of patients with morbid obesity. The selected domains are described better than by the previously used Barthel scale. Women with morbid obesity tend to have more impaired mental functioning than morbidly obese men

Percutaneous tricuspid edge-to-edge repair — patient selection, imaging considerations, and the procedural technique. Expert opinion of the Working Group on Echocardiography and Association of CardioVascular Interventions of the Polish Cardiac Society

Tricuspid regurgitation (TR) is a common acquired valvular heart disease (VHD). TR has progressive character and is associated with impaired long-term survival in both symptomatic and asymptomatic subjects. Despite this knowledge, the overall number of tricuspid valve surgeries is very low worldwide and many patients with clear indications for intervention are left untreated. The development of less invasive transcatheter techniques may offer new treatment options in this growing population of patients. Out of various percutaneous methods proposed, tricuspid edge-to-edge repair has recently gained considerable attention. The article summarizes available data regarding this new treatment method

Temporal trends of transcatheter aortic valve implantation in a high-volume academic center over 10 years

Background: Indications for transcatheter aortic valve implantation (TAVI) have gradually expanded since its introduction.Aims: The aim was to analyze temporal trends in TAVI characteristics based on the experience of a high-volume academic center over the period of 10 years.Methods: Five hundred and six consecutive (n = 506) patients with 1-year follow-up were divided into early (G1, years 2010–2013, n = 130), intermediate (G2, 2014–2016, n = 164) and recent (G3, 2017–2019, n = 212) experience groups.Results: Patient’s age remained constant over time (mean [SD]; G1 = 79.1 [7.1] years vs G2 = 79.1 [7.1] years vs G3 = 79.7 [6.6] years, P = 0.73) but surgical risk in G3 was lower (log Euroscore, median [IQR]: G1 = 14.0 [8.4–20.2] vs G2 = 12.0 [7.0–22.2] vs G3 = 5.1 [3.5–8.5]; P <0.001). Major/life-threatening bleeding (G1 = 26.9% vs G2 = 12.8% vs G3 = 9.4%; P <0.001), major vascular complications (G1 = 15.4% vs G2 = 8.5% vs G3 = 5.7%; P = 0.02) and moderate/severe paravalvular leak (G1 = 16.2% vs G2 = 11% vs G3 = 7.5%; P = 0.046) were decreasing with time. There was a significant drop in all-cause 1-year mortality in G3 (G1 = 20% vs G2 = 17.7% vs G3 = 9.1%; log rank = 0.01).Conclusions: The age of TAVI recipients remained unchanged over the last decade. Decreasing surgical risk coupled with improvements in procedural technique and care resulted in fewer periprocedural complications and better 1-year survival