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Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation.

ABSTRACT: Background: This aim of this study was to clarify prognosis after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and to identify baseline factors associated with mortality. Methods?and?Results: We prospectively enrolled 257 consecutive elderly persons with AS who were referred to Keio University Hospital and who underwent assessment of cardiac, physical (walking speed), cognitive, and renal functions, nutritional status, activities of daily living (ADL), instrumental ADL (IADL) assessed with the Frenchay activities index (FAI), and comorbidities. The primary outcome was postoperative death. Differences in basic characteristics were compared between a group that survived for a median of 661 days (IQR, 0-1,289 days) after TAVI and a group that did not. Multivariate hazard ratios (HR) were calculated for independent factors selected in Cox proportional hazard models. Thirty-one individuals died during follow-up. Walking speed was significantly faster (0.87±0.25 vs. 0.70±0.24 m/s, P<0.001) and FAI was significantly higher (21.2±8.0 vs. 15.7±8.0, P=0.026) in the survival group compared with those who died. Multivariate HR for mortality according to walking speed was 0.05 (95% CI: 0.028-0.091) in model 1 and 0.04 (95% CI: 0.020-0.081) in model 2, and those for FAI were 0.94 (95% CI: 0.92-0.95) and 0.92 (95% CI: 0.90-0.92), respectively. Conclusions: Preoperative walking speed and IADL are crucial factors associated with prognosis after TAVI even after adjustment.

SUBMITTER: Fukui S

PROVIDER: S-EPMC7929760 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation.

Fukui Shogo S Kawakami Michiyuki M Otaka Yohei Y Ishikawa Aiko A Yashima Fumiaki F Hayashida Kentaro K Oguma Yuko Y Fukuda Keiichi K Liu Meigen M

Circulation reports 20200108 2

Background: This aim of this study was to clarify prognosis after transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS) and to identify baseline factors associated with mortality. Methods and Results: We prospectively enrolled 257 consecutive elderly persons with AS who were referred to Keio University Hospital and who underwent assessment of cardiac, physical (walking speed), cognitive, and renal functions, nutritional status, activitie ...[more]

PMID: 33693212

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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.

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Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation.

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Preoperative Instrumental Activities of Daily Living Predicts Survival After Transcatheter Aortic Valve Implantation.

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