Dataset Information

Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation.

ABSTRACT:

Background

Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI.

Methods and results

Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II-IV) at baseline, NYHA functional class improved in 592 (86.5%) and remained unchanged/worsened in 92 (13.5%) at follow-up [median (IQR): 419 (208-807) days] after TAVI. Normal functional capacity (NYHA I) was recovered in 65.5% (n = 448) of patients, while the rest had variable degrees of residual impairment. On multivariable regression analysis, atrial fibrillation [odds ratio-OR, 2.08 (1.21-3.58), p = 0.008], low-flow-low-gradient AS [OR, 1.97 (1.09-3.57), p = 0.026], chronic obstructive pulmonary disease [OR, 1.92 (1.19-3.12), p = 0.008], and lower hemoglobin at baseline [OR, 1.11 (1.01-1.21) for each g% decrement, p = 0.036] were independently associated with residual impairment of functional capacity. All-cause and cardiac mortality were significantly higher in those with residual impairment of functional capacity than in those in NYHA I class [hazard ratio-HR: 2.37 (95% CI: 1.51-3.72), p < 0.001 and 2.16 (95% CI: 1.08-4.35), p = 0.030, respectively]. Even mild residual functional impairment (NYHA II) was associated with a higher all-cause [HR: 2.02 (95% CI: 1.10-3.72), p = 0.023] and cardiac [HR: 2.08 (95% CI: 1.42-3.07), p < 0.001] mortality.

Conclusion

Residual impairment of functional capacity is common after TAVI and is independently associated with increased mortality. Predictors of residual impairment of functional status are predominantly patient-rather than procedure-related.

SUBMITTER: Abdelghani M

PROVIDER: S-EPMC5565654 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Publications

Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation.

Abdelghani Mohammad M Cavalcante Rafael R Miyazaki Yosuke Y de Winter Robbert J RJ Sarmento-Leite Rogério R Mangione José A JA Abizaid Alexandre A Lemos Pedro A PA Serruys Patrick W PW de Brito Fabio S FS

Clinical research in cardiology : official journal of the German Cardiac Society 20170425 9

<h4>Background</h4>Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI.<h4>Methods and results</h4>Out of 790 patients underg ...[more]

PMID: 28444455

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Project description:ObjectiveTranscatheter aortic valve implantation (TAVI) procedures are increasing rapidly, but the durability of tissue valve and periprocedural complications are not satisfactory. Immune reaction to the galactose-α-1,3 galactose β-1,4-N-acetylglucosamine (α-Gal) and conventional processing protocols of cardiac xenografts lead to calcification. Next-generation TAVI needs to be made with α-Gal-free xenografts by multiple anticalcification therapies to avoid immune rejection and enhance durability, and three-dimensional (3D) printing technology to improve the procedural safety.MethodsPorcine pericardia were decellularized and immunologically modified with α-galactosidase. The pericardia were treated by space filler, crosslinked with glutaraldehyde in organic solvent, and detoxified. The sheep-specific nitinol (nickel-titanium memory alloy) wire backbone was made from a 3D-printed model for ovine aortic root. After it passed the fitting test, we manufactured a self-expandable stented valve with the porcine pericardia mounted on the customized nitinol wire-based stent. After in vitro circulation using customized silicone aortic root, we performed TAVI in 9 sheep and obtained hemodynamic, radiological, immunohistopathological, and biochemical results.ResultsThe valve functioned well, with excellent stent fitting and good coronary flow under in vitro circulation. Sheep were sequentially scheduled to be humanely killed until 238 days after TAVI. Echocardiography and cardiac catheterization demonstrated good hemodynamic status and function of the aortic valve. The xenografts were well preserved without α-Gal immune reaction or calcification based on the immunological, radiographic, microscopic, and biochemical examinations.ConclusionsWe proved preclinical safety and efficacy for next-generation α-Gal-free TAVI with multiple anticalcification therapies and 3D-printing technology. A future clinical study is warranted based on these promising preclinical results.

Dataset Information

Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation.

Background

Methods and results

Conclusion

Publications

Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation.

Similar Datasets

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