Delirium as late manifestation of infective endocarditis after transcatheter aortic valve implantation.

More than one-third of the cases of infective endocarditis (IE) occur in older patients. The disease is often characterized by atypical symptoms. The incidence of neurological complications is high and represents a strong independent predictor of severe outcomes and mortality. IE is a rare but serious complication of transcatheter aortic valve implantation (TAVI). A persistent delirium as a unique manifestation of post-TAVI IE in an older patient is presented in this clinical case.

Identifying Factors That Impact the Time between Tavr Referral and Intervention

Background Over the past 20 years, transcatheter aortic valve replacement (TAVR) has been safely and rapidly adopted in the U.S., representing a paradigm shift in the management of aortic stenosis. Despite the growing demand for TAVR, little is known about the process from referral to TAVR (time to TAVR). This survey-based study aims to identify factors that impact this process. Methods In 2022, an online survey was emailed to structural heart program coordinators at a large health system (27 programs, n=27) to assess structure-, process-, and patient-related factors that impact the time to TAVR. Descriptive statistics of key care pathway checkpoints, and barriers encountered in the process are reported. Results The response rate was 81% (n=22). Most programs reported taking 3 days or less from the valve clinic referral to 1st contact with pt (n=15, 68%), 2 weeks or less from 1st contact to 1st clinic visit (n=17, 77%), and 2 weeks or less from 1st clinic visit to scheduled TAVR (n=16, 73%). Staffing, scheduling computed tomography, COVID restrictions, authorizations, comorbidities were common barriers impacting the time to TAVR. Conclusion Understanding factors impacting the time to TAVR as well as key metrics of efficiency along this process is critical for responding to its growing demand. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Trends and Predictors of Short Wait Time for Transcatheter Aortic Valve Replacement in a Rural Health Care Network

Background Prolonged wait times for Transcatheter Aortic Valve Replacement (TAVR) are associated with increased mortality. Rural health care systems may have challenges in efficiency due to travel related delays. We determined temporal trends and predictors of Short TAVR Wait Time (STWT: TAVR <=30 days from first referral). Methods We identified 918 consecutive patients with Aortic Stenosis (AS) undergoing TAVR from 1/1/19-6/30/22 at a rural tertiary care center. Patients with wait times?>90 days (N=87) were excluded due to patient preferences or treatment of comorbidities. We assessed TAVR wait times (means and STWT%) over time and determined the impact of COVID 19 onset (3/1/20) and driving distance on TAVR efficiency. Results Half of the cohort achieved STWT (51%). TAVR volumes, patient age, sex, and comorbidities were generally stable over time. Mean wait times decreased despite the onset of COVID 19: pre-COVID 36+/- 19 vs post-COVID 31+/- 19 days (p=0.003) (Figure). There was no interaction of travel distance and mean wait time: 33+/- 19 days <= 60 miles vs 32+/- 19 days?> 60 miles (P=NS). Conclusion TAVR efficiency improved over the past 4 years with one half of patients experiencing a STWT. Neither COVID 19 nor long travel distance negatively impacted TAVR efficiency in a rural health care network. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

CRT-200.02 National Trends of Structural Heart Disease Interventions From 2016 to 2020 in the United States and the Associated Impact of COVID-19 Pandemic

Introduction: The Coronavirus Disease-2019 (COVID-19) pandemic placed an enormous strain on the healthcare system. Data on the impact of COVID-19 on the utilization and outcomes of structural heart disease (SHD) interventions in the United States are scarce. Method(s): The National Inpatient Sample from 2016 to 2020 was queried to identify adult admissions for transcatheter aortic valve replacement (TAVR), left atrial appendage occlusion (LAAO), and transcatheter end-to-end repair (TEER). The primary outcome was temporal trends of procedure utilization rate per 100,000 admissions over quarters from 2016 to 2020. The secondary outcomes were adjusted rates of in-hospital mortality, major complications, and length of stay (LOS). Result(s): Among 434,630 weighted admissions (TAVR: 305,550;LAAO: 89,300;TEER: 40,160), 95,010 admissions (22%) were during the COVID-19 era. There was a decline during the second quarter of 2020 followed by an increase to the pre pandemic levels (TAVR: 220 to 253, LAAO: 57 to 109, and TEER:31 to 36 per 100,000 admissions, Ptrend<0.001) (Figure). There were no differences in the mortality or major complication rates. Median LOS has decreased in TAVR (4 days to 1 day) and in TEER (3 days to 1 day) but remained stable in LAAO (1 day). Conclusion(s): This nationwide analysis showed that SHD interventions decreased during the early waves of COVID-19 pandemic. There was a significant reduction in hospital LOS without differences in in-hospital mortality or complication rates during the pandemic. These data suggest that hospitals adapted to the unprecedent challenges during the pandemic to provide advanced cardiac care to patients. [Formula presented]Copyright © 2023

Recurrent Embolic Strokes in a Young Patient - a Case of Late Tavr Thrombosis and Endocarditis

Background Late complications of transcatheter aortic valve replacement (TAVR) are uncommon. We present a patient two-years post TAVR with recurrent strokes. Case A 56-year-old male with history of TAVR and pacemaker first presented with left-sided weakness found to have acute right MCA strokes and COVID. TTE showed a non-thickened valve with normal gradients and device interrogation revealed no arrhythmias. Six months later, he presented with acute left MCA strokes as well as new murmur, leukocytosis, and splenic infarcts on CT. TTE demonstrated a prosthetic aortic valve mean gradient of 43mmHg. TEE confirmed leaflet thrombosis with severe prosthetic aortic stenosis and mobile thrombus (Figure 1). Multiple sets of blood cultures were negative. Decision-making He was first treated with therapeutic anticoagulation but switched to broad spectrum antibiotics with increasing evidence for infection. He underwent Ross procedure with intra-operative evidence of multiple aortic root abscesses (Figure 1). PCR sequencing of the vegetation revealed staphylococcus species related to S. Haemolyticus. His course may be best explained by embolic stroke caused by progressive TAVR thrombosis in the setting of COVID-associated coagulopathy and subsequent superinfection leading to endocarditis and septic emboli. Conclusion Late TAVR thrombosis and endocarditis are rare complications. TAVR patients presenting with stroke merit prompt evaluation with dedicated echocardiographic imaging. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

The SWISS PCI Survey - coronary and structural heart interventions in Switzerland 2020

For almost 35 years, the Swissworking Group for interventional Cardiology of the Swiss Society of Cardiology has evaluated and assessed the invasive diagnostic and therapeutic heart interventions performed annually in Switzerland.the aim of this survey, which was completed by 36 centres using a standardised questionnaire, was to report the data for the year 2020. Overall, 53,088 coronary angiographies with 48.8% subsequent percutaneous coronary interventions, i.e., 8.6% less than in 2019, were performed. regarding structural interventions, there were 1790 transcatheter aortic valve implantations, with a decrease of 6.4% compared with 2019.this decrease was most likely due to the coronavirus disease (COvid-19) pandemic and its consequences on the Swiss healthcare system.Copyright © 2021 Edizioni Minerva Medica.

Acute Transcatheter Aortic Valve Replacement Failure Secondary to Covid-19 Infection

Background Valve thrombosis is a documented cause of prosthetic valve failure. Common features include increased cusp thickness, reduced cusp mobility, and increased transvalvular gradient. Case reports have been published of prosthetic valve thrombosis secondary to COVID-19 infection, but this may represent the first documented case of bioprosthetic transcatheter aortic valve replacement (TAVR) thrombosis in the setting of COVID-19. Case A 90 year-old female with atrial fibrillation on apixaban and severe aortic stenosis status-post TAVR with normal valve function on recent echocardiogram presented in clinic with acute chest pain. She was found to have COVID-19 infection and severe bioprosthetic valvular regurgitation with leaflet thickening, abnormal cusp mobility, and elevated transvalvular gradient. [Formula presented] Decision-making Given the time course of valve failure, COVID-19 infection, and echocardiographic features, the patient was diagnosed with bioprosthetic valve thrombosis secondary to COVID-19. She was optimized with diuresis and continued on apixaban before undergoing valve-in-valve TAVR with resolution of valvular dysfunction. Conclusion This case contributes to a body of literature describing thrombotic complications in patients with valve replacement and COVID-19 infection despite concurrent anticoagulation. Increased vigilance and investigations are warranted to better characterize thrombotic risk and optimal antithrombotic strategies in this patient populace.Copyright © 2023 American College of Cardiology Foundation

Transcatheter aortic valve implantation using the SAPIEN 3 valve to treat aortic regurgitation: The French multicentre S3AR study.

BACKGROUND: Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation. AIMS: We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves. METHODS: We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve. RESULTS: A total of 37 patients (male sex, 73%) with a median age of 81years (interquartile range 69-85years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n=31) had dyspnoea New York Heart Association class≥III. The device success rate was 94.6% (n=35). At 30days, the all-cause mortality rate was 8.1% (n=3) and valve migration occurred in 10.8% of cases (n=4). Dyspnoea New York Heart Association class≤II was seen in 86.5% of patients (n=32), and all survivors had aortic regurgitation grade≤1. At 1-year follow-up, all-cause mortality was 16.2% (n=6), 89.7% (n=26/29) of survivors were in New York Heart Association class≤II and all had aortic regurgitation grade≤2. CONCLUSION: Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.

The Impact of COVID-19 on Racial and Ethnic Disparities in Cardiac Procedural Care.

OBJECTIVE: The primary objective of this study was to evaluate whether the COVID-19 pandemic altered the racial and ethnic composition of patients receiving cardiac procedural care. DESIGN: This was a retrospective observational study. SETTING: This study was conducted at a single tertiary-care university hospital. PARTICIPANTS: A total of 1,704 adult patients undergoing transcatheter aortic valve replacement (TAVR) (n = 413), coronary artery bypass grafting (CABG) (n = 506), or atrial fibrillation (AF) ablation (n = 785) from March 2019 through March 2022 were included in this study. INTERVENTIONS: No interventions were performed as this was a retrospective observational study. MEASUREMENTS AND MAIN RESULTS: Patients were grouped based on the date of their procedure: pre-COVID (March 2019 to February 2020), COVID Year 1 (March 2020 to February 2021), and COVID Year 2 (March 2021 to March 2022). Population-adjusted procedural incidence rates during each period were examined and stratified based on race and ethnicity. The procedural incidence rate was higher for White patients versus Black, and non-Hispanic patients versus Hispanic patients for every procedure and every period. For TAVR, the difference in procedural rates between White patients versus Black patients decreased between the pre-COVID and COVID Year 1 (12.05-6.34 per 1,000,000 persons). For CABG, the difference in procedural rates between White patients versus Black, and non-Hispanic patients versus Hispanic patients did not change significantly. For AF ablations, the difference in procedural rates between White patients versus Black patients increased over time (13.06 to 21.55 to 29.64 per 1,000,000 persons in the pre-COVID, COVID Year 1, and COVID Year 2, respectively). CONCLUSION: Racial and ethnic disparities in access to cardiac procedural care were present throughout all study time periods at the authors' institution. Their findings reinforce the continuing need for initiatives to reduce racial and ethnic disparities in healthcare. Further studies are needed to fully elucidate the effects of the COVID-19 pandemic on healthcare access and delivery.

"Be Your Own Doctor" Experiences of Patients With Transcatheter Aortic Valve Implantation During the Pandemic: A Qualitative Study.

Background and Purpose: Although patients have had reduced access to healthcare institutions due to the COVID-19 pandemic and the related preventive measures, there is no current data on how the pandemic has affected patients who underwent transcatheter aortic valve implantation (TAVI), despite their need for close follow-up.This study investigated TAVI patients' experiences with self-care management during the pandemic. Methods: This study adopted a descriptive qualitative design. The sample consisted of 24 patients recruited using purposive sampling. Data were collected by telephone and analyzed using inductive content analysis. Results: The data were grouped under three themes: "vulnerability," "worsening of psychological condition," and "expectations." The most challenging self-care behaviors reported by TAVI patients were determined to be doing regular physical activity, managing their symptoms, complying with treatment, and attending regular check-ups. They also reported experiencing psychological problems such as fear, concern, and abandonment and stated a need for better communication and follow-up at home during the pandemic. Implications for Practice: The pandemic has more than ever demonstrated the importance of effective self-care for cardiovascular patients. Nurses should plan individualized interventions regarding the problems in self-care management that we identified in this study. In this regard, the use of secure digital applications such as telerehabilitation can be effective. Also, nurses should develop community-based and political initiatives to allow sustainable self-care management to be effectively implemented in special patient groups in extraordinary circumstances such as pandemics.

A European update on transcatheter aortic valve implantation (TAVI) in the COVID era.

Minimally invasive approaches for aortic valve replacement are now at the forefront of pathological aortic valve treatment. New trials show comparability of these devices to existing therapies, not only in high-risk surgical cohorts but also in low-risk and intermediate-risk cohorts. This review provides vital clinical and anatomical background to aortic valvular disease treatment guidelines, while also providing an update on transcatheter aortic valve implantation (TAVI) devices in Europe, their interventional trials and associated complications.

Transcatheter Aortic Valve Replacement vs. Surgical Aortic Valve Replacement for Long-Term Mortality Due to Stroke and Myocardial Infarction: A Meta-Analysis during the COVID-19 Pandemic.

Background and objectives: One of the leading causes of mortality and morbidity in people over the age of 50 is stroke. The acceptance of transcatheter aortic valve replacement (TAVR) as a treatment option for severe symptomatic aortic stenosis (AS) has increased as a result of numerous randomized clinical trials comparing surgical aortic valve replacement (SAVR) and TAVR in high- and intermediate-risk patients, showing comparable clinical outcomes and valve hemodynamics. Materials and Methods: An electronic search of Medline, Google Scholar and Cochrane Central was carried out from their inception to 28 September 2022 without any language restrictions. Results: Our meta-analysis demonstrated that, as compared with SAVR, TAVR was not linked with a lower stroke ratio or stroke mortality. It is clear from this that the SAVR intervention techniques applied in the six studies were successful in reducing cardiogenic consequences over time. Conclusions: A significantly decreased rate of mortality from cardiogenic causes was associated with SAVR. Additionally, when TAVR and SAVR were compared for stroke mortality, the results were nonsignificant with a p value of 0.57, indicating that none of these procedures could decrease stroke-related mortality.

Spanish cardiac catheterization and coronary intervention registry. 31st official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2021)

Introduction and objectives: The Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) presents its annual activity report for 2021. Methods: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company, together with the members of the ACI-SEC. Results: A total of 121 centers participated (83 public and 38 private). Compared to 2020, both diagnostic coronary angiograms and percutaneous coronary interventions (PCI) increased by 11,4% and 10,3%, respectively. The radial approach was the most used access (92,8%). Primary PCI also increased by 6.2% whereas rescue PCI (1,8%) and facilitated PCI (2,4%) were less frequently conducted. Transcatheter aortic valve implantation was one of the interventions with the most relevant increase. A total of 5720 transcatheter aortic valve implantation procedures were conducted with an increase of 34,9% compared to 2020 (120 per million in 2021 and 89,4 per million in 2020). Other structural interventions like transcatheter mitral or tricuspid repair, left atrial appendage occlusion and patent foramen oval closure also experienced a significant increase. Conclusions: The 2021 registry demonstrates a clear recovery of the activity both in coronary and structural interventions showing a relevant increase compared to 2020, the year of the COVID-19 pandemic.

Changes in treatment of aortic valve diseases for acute and elective indications during the COVID-19 pandemic: A retrospective single-center analysis from 2019 to 2020.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic had an impact on the quality of healthcare services and led to many changes in the treatment of cardiac pathologies. OBJECTIVES: To assess the differences in the clinical manifestations, management and outcomes of patients with aortic valve diseases (AVDs) treated invasively before and during the pandemic. MATERIAL AND METHODS: This retrospective single-center study involved patients with AVDs treated by means of balloon aortic valvuloplasty (BAV), transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) in 2019 and 2020. They were divided into groups with respect to the year of intervention (2019 compared to 2020) and the priority of admission (urgent compared to elective). Preoperative characteristics, early outcomes and probability of annual survival were compared between the groups. RESULTS: The number of patients admitted urgently increased from 37 in 2019 to 54 in 2020, with a higher prevalence of men in 2020 (83.3% compared to 56.8%, respectively). Elective cases, on the other hand, declined from 279 in 2019 to 256 in 2020. Among the latter, more subjects had manifestations of heart failure (p < 0.001), coronary artery disease (CAD; p = 0.002), hypertension (p = 0.006), as well as had a history of a stroke (p = 0.002). In the meantime, more TAVI and fewer SAVR procedures were performed in 2020 (86 compared to 127 and 192 compared to 125, respectively; p < 0.001). In 2020, TAVI individuals had risk of death (according to the EuroSCORE scale) than in 2019 (p < 0.001). The probability of annual survival was comparable (p = 0.769) among AVD patients treated before and during the coronavirus pandemic (91.3% compared to 88.3%, respectively). CONCLUSION: Although during the COVID-19 pandemic more nonelective and higher-risk AVD individuals received interventional treatment, the outcomes were comparable to the pre-pandemic era (2019). Our findings support highly valuable, less invasive therapeutic methods for treating aortic pathologies during the pandemic.

Transatrial Balloon-Expandable Valve Implantation for Symptomatic Mitral Stenosis With Severe Annular Calcification—A Hybrid Solution

Background: Treatment of symptomatic mitral valve stenosis in severe mitral annular calcification is a surgical challenge. Transcatheter options include transfemoral transcatheter mitral valve replacement (TMVR), which poses its own risks, the most significant is left ventricular outflow tract (LVOT) obstruction. Transatrial hybrid TMVR optimizes advantages of both traditional open-heart surgery and transcatheter valve replacement. Methods: Retrospective review of seven high-risk patients (deemed ineligible for traditional surgery) undergoing transatrial implantation of a SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA) in the mitral position for severe symptomatic mitral stenosis. Laceration of the Anterior Mitral leaflets to Prevent Outflow ObstructioN procedure was not considered due to heavy leaflet calcifications. Results: Seven patients treated consecutively from June 2020 to July 2021 were included in this analysis. Mean age was 77 years;six were females, one was male. Average STS score was 9.8. Three patients had New York Heart Association (NYHA) class IV heart failure. Mean left ventricular ejection fraction was 62%. Dominant mitral valve pathology included mitral stenosis in all patients. Mean mitral valve gradient was 12 mmHg. All patients had circumferential annular calcification except one, who had predominantly anterior calcification. All patients received the Edwards SAPIEN 3 valve and had anterior leaflet resection. Surgical approach was at the discretion of the attending cardiac surgeon. Mean cardiopulmonary bypass time was 85 minutes;mean cross-clamp time was 36 minutes. No anchoring felt was used. Technical success was 100%, with no device embolization. There was no clinically significant LVOT obstruction. There were two deaths: one occurred during index hospitalization due to worsening heart failure secondary to torrential tricuspid regurgitation, and the second was 2 months later due to COVID-19 infection. Conclusion: Surgical hybrid transatrial TMVR for patients at high surgical risk is technically feasible with high procedure success. A relatively shorter cardiac ischemic duration, direct visualization and resection of the anterior mitral leaflet can allow for safe TMVR without risk of LVOT obstruction.

THE TRUTH THE TEETH TOLD: THE UNUSUAL CASE OF A SUBPHRENIC MASS

CASE: A 75-year-old man with a history of aortic stenosis status post transcatheter aortic valve replacement (TAVR), compensated cirrhosis in the setting of alcohol use disorder, and osteoarthritis presented with hyper-acute dyspnea and chest pain that awoke him from sleep. Three years prior to admission, an abdominal computed tomography (CT) for his TAVR evaluation revealed a 2 cm, irregular, peripherally-enhancing mass in the right subphrenic space, most concerning for malignancy but stable in size a year later. Further work-up was delayed due to the COVID-19 pandemic. One week prior to this presentation, he returned to care with 6 months of progressive right shoulder pain, pleuritic chest pain, and 5 kg of unintentional weight loss and was found to have growth of the right subphrenic mass to 4.9 cm, for which he underwent interventional radiology-guided aspiration and biopsy from a subxiphoid approach. Pathology on the core biopsy was inconclusive, revealing granulation tissue with chronic inflammatory changes and negative routine cultures. He was hemodynamically stable and discharged home. On admission, he was afebrile, tachypneic to 26, tachycardic to 120, hypotensive to 80/40, and saturating 94% on room air. He was found to have a large pericardial effusion with tamponade physiology, upon which 500 mL of serous fluid was drained via emergent pericardiocentesis. Laparoscopic biopsy of the subphrenic mass revealed a purulent fluid collection. 16S/18S sequencing and MALDI cultures were most consistent with Actinomyces spp. With further history-taking alongside an Italian language interpreter, he was found to have had prior dental abscesses, the likely origin of his Actinomyces infection, although the curious propensity for the subphrenic location remains unknown. Periodontal disease had been diagnosed but not fully treated given lack of insurance coverage and perceived importance. His pericarditis and ensuing tamponade was attributed to irritation and seeding from the subxiphoid approach for attempted fluid aspiration. IMPACT/DISCUSSION: Actinomyces spp. are a part of the normal human gut and oral cavity flora, but when pathogenic, they are often associated with dental, pulmonary, and urinary tract infections. In addition to periodontal disease, this patient's risk factors for Actinomyces abscess formation include cirrhosis (via transient gut translocation from elevated portal pressures) and alcohol use disorder (via increased aspiration risk). There have been several reports of Actinomyces spp. causing pericarditis and tamponade following seeding from liver, lung, and oral cavity abscesses- to our knowledge, however, none from subphrenic abscesses. CONCLUSION: This case highlights the importance of an oral health history in work-up of an indolent growing thoracic mass and the challenges in comprehensive history-taking in patients with limited English proficiency. Increasing coverage of dental services (e.g. a Medicare dental benefit) is key to health and health equity.

Prevalence and severity of cognitive dysfunction in patients referred for transcatheter aortic valve implantation (TAVI): clinical and cognitive impact at 1 year.

AIM: We estimated the proportion and severity of cognitive disorders in an unselected population of patients referred for transcatheter aortic valve implantation (TAVI). Second, we describe clinical and cognitive outcomes at 1 year. METHODS: Eligible patients were aged ≥ 70 years, with symptomatic aortic stenosis and an indication for TAVI. The Montreal Cognitive Assessment (MoCA) was used to assess cognitive dysfunction (CD), defined as no CD if score ≥ 26, mild CD if 18-25; moderate CD if 10-18, and severe CD if < 10. We assessed survival and in-hospital complications at 6 months and 1 year. RESULTS: Between June 2019 and October 2020, 105 patients were included; 21 (20%) did not undergo TAVI, and thus, 84 were analyzed; median age 85 years, 53.6% females, median EuroScore 11.5%. Median MoCA score was 22 (19-25); CD was excluded in 18 (21%), mild in 50 (59.5%), moderate in 15 (19%) and severe in 1. Mean MoCA score at follow-up was 21.9(± 4.69) and did not differ significantly from baseline (21.79 (± 4.61), p = 0.73). There was no difference in success rate, in-hospital complications, or death across CD categories. CONCLUSION: The clinical course of patients with mild or moderate CD is not different at 1 year after TAVI compared to those without cognitive dysfunction.

Next-Day Discharge Following Transcatheter Aortic Valve Implantation: An Australian Tertiary Hospital Experience

Background: With increasing utilisation of transcatheter aortic valve implantation (TAVI) for aortic stenosis, there is a need to explore the safety of next-day discharge. We aimed to evaluate the safety and outcomes of next-day discharge following TAVI. Methods: We performed a retrospective analysis of patients who underwent TAVI at a tertiary centre between 2020 and 2021. Included patients were those discharged the next day after TAVI as routine care. Data collected included baseline demographics, Society of Thoracic Surgeons (STS) score, perioperative complications and 30-day mortality rates. Results: Thirty-three patients (33% female, median age 82 years;interquartile range [IQR], 77–84) were discharged the next day post-TAVI. Median STS score was 2.3% (IQR, 1.7–3.6). On pre-TAVI ECG, two patients (6%) had right bundle branch block (QRS duration 147–154 ms). All patients demonstrated well-seated aortic valve prosthesis with no aortic regurgitation on same-day transthoracic echocardiogram. Six patients (18%) had new conduction abnormalities post-TAVI (five transient left bundle branch block, one atrial fibrillation which self-resolved). There were no significant procedural complications including no pericardial effusion or vascular injury. All patients were discharged directly home without the need for subacute care. Two patients (6%) were re-hospitalised within 30 days of discharge: one admitted with presyncope of unclear cause and one required a pacemaker for tachy-brady syndrome. All patients were alive and well at 30 days. Conclusion: We have demonstrated that next-day discharge TAVI is safe in selected patients with an uncomplicated procedure. In the era of COVID, implementation of next-day discharge can reduce unnecessary length of stay and may improve hospital resource allocation.

Chronic Kidney Disease and Transcatheter Aortic Valve Implantation (TAVI): An Australian Experience

Background: Acute kidney injury (AKI) is an independent risk factor for chronic kidney disease (CKD) [1]. There is growing evidence to suggest AKI maybe an independent risk factor for morality post TAVI, particularly in patients with pre-existing CKD [2]. There are mixed data available regarding the outcomes of patients with CKD who undergo TAVI. Although TAVI has demonstrated favourable outcomes in high-risk surgical candidates, compared with medical therapy, it remains unclear the impact the procedure has on renal outcomes [3]. To date, robust data are lacking regarding renal outcomes in patients with CKD undergoing TAVI. It remains unclear if TAVI is beneficial in the dialysis population. Therefore, we sought to analyse renal outcomes in patients undergoing TAVI in Australia, with and without CKD. Methods: We performed a retrospective registry analysis of prospectively collated data. TAVI patients recruited to the Australasian Cardiac Outcomes Registry (ACOR) were included in the study. The primary outcome for analysis was progression to end stage renal failure at 12 months post procedure. Secondary outcomes included progression of CKD stage at 12 months post procedure, AKI beyond 30 days post procedure and need for dialysis within 3 months post procedure. We also performed a subgroup analysis according to baseline CKD stage for the primary and secondary outcomes. Results: Considering the COVID-19 pandemic, final release of the data set from the registry is incomplete. We fully expect an exploratory analysis with formal results and conclusions to be complete and ready for presentation and subsequent publication at the time of the conference.