Edwards SAPIEN Versus Medtronic Aortic Bioprosthesis in Women Undergoing Transcatheter Aortic Valve Implantation (from the Win-TAVI Registry).

We sought to analyze outcomes of women receiving balloon-expandable valves (BEV) or self-expanding valves (SEV) in contemporary transcatheter aortic valve implantation (TAVI). WIN TAVI (Women's INternational Transcatheter Aortic Valve Implantation) is the first all-female TAVI registry to study the safety and performance of TAVI in women. We compared women treated with BEV (n = 408, 46.9%) versus those treated with SEV (n = 461, 53.1%). The primary efficacy end point was the Valve Academic Research Consortium-2 (VARC-2) composite of 1-year all-cause death, stroke, myocardial infarction, hospitalization for valve-related symptoms or heart failure or valve-related dysfunction. Women receiving SEV had higher surgical risk scores, higher rate of previous stroke and pulmonary hypertension whereas women receiving BEV were more frequently denied surgical valve replacement due to frailty. BEV patients were less likely to require post-dilation and had significantly lower rates of residual aortic regurgitation grade ≥2 (9.8% vs 4.7%, p = 0.007). At 1 year, the crude incidence and adjusted risk of the primary VARC-2 efficacy end point was similar between groups (17.1% with SEV and 14.3% with BEV, p = 0.25; hazards ratio 1.09, 95% confidence interval 0.68 to 1.75). Conversely the crude rate and adjusted risk of new pacemaker implantation was higher with SEV than BEV (15% vs 8.6%, p = 0.001; hazards ratio 1.97, 95% confidence interval 1.13 to 3.43). A subanalysis on new generation valves showed no difference in the need for pacemaker implantation between the 2 devices (10.1% vs 8.0%, p = 0.56). In conclusion, in contemporary TAVI, SEV are used more frequently in women with greater co-morbidities. While there were no differences in unadjusted and adjusted risk of 1-year primary efficacy end point between the valve types, there was a greater need for permanent pacemakers after SEV implantation.

Impact of Discharge Location After Transcatheter Aortic Valve Replacement on 1-Year Outcomes in Women: Results From the WIN-TAVI Registry.

BACKGROUND: Several clinical and procedural factors determine outcomes after transcatheter aortic valve replacement (TAVR), but data are scarce on the impact of post-TAVR discharge disposition on long-term outcomes. We sought to analyse whether discharge location after TAVR is associated with 1-year outcomes in women undergoing contemporary TAVR. METHODS: The Women's INternational Transcatheter Aortic Valve Implantation (WIN-TAVI) registry is the first all-female TAVR registry to study the safety and performance of contemporary TAVR in women (n = 1019). Information on discharge location was available in 817 patients (80.2%). We compared women discharged home vs those discharged to another location (nursing home, rehabilitation, or other hospital). One-year outcomes were adjusted using multivariable Cox regression methods with discharge home as the reference group. RESULTS: Of the study subjects, 75.2% (n = 614) were discharged home and 24.8% (n = 203) to another location. Women discharged to other locations were older with a greater prevalence of severe lung disease requiring home oxygen and renal failure on dialysis but were less frequently considered frail or at high surgical risk compared with women discharged home. After multivariable adjustment, non-home discharge was associated with greater hazard for 1-year Valve Academic Research Consortium 2 efficacy (21.3% vs 10.8%, hazards ratio [HR] 1.9, 95% confidence interval [CI] 1.2-2.9) and safety endpoints (31.5% vs 15.2%, HR 2.1, 95% CI 1.5-3.0), cardiovascular death (12.7% vs 5.5%, HR 2.0, 95% CI 1.1-3.6), and stroke (6.5% vs 0.8%, HR 8.5, 95% CI 2.9-25.6). CONCLUSIONS: In women undergoing contemporary TAVR, discharge disposition significantly affects 1-year risk of outcomes even after adjustment for recorded baseline differences. This might suggest the necessity of considering additional factors beyond comorbidities in the TAVR decision-making process.

[The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome]. / Importancia del sondaje de la arteria mamaria antes de cirugía coronaria en el síndrome de Leriche.

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery.

Importancia del sondaje de la arteria mamaria antes de cirugía coronaria en el síndrome de Leriche / The importance of investigating the internal thoracic artery before coronary artery surgery in Leriche's syndrome

La enfermedad arterial periférica y la enfermedad coronaria frecuentemente coexisten en un mismo paciente. En los pacientes con oclusión de la aorta abdominal (síndrome de Leriche) o del eje femoroiliaco, la circulación colateral a extremidades inferiores puede originarse en ramas de la aorta abdominal o incluso en la arteria mamaria interna (en función del grado de la oclusión). Es importante filiar, durante el procedimiento diagnóstico, el origen de esta circulación, especialmente en los pacientes que pueden necesitar revascularización coronaria quirúrgica, ya que en los casos con circulación colateral procedente en su mayoría de la arteria mamaria interna, su uso como injerto coronario puede ocasionar isquemia aguda en las extremidades inferiores. Presentamos los casos de 3 pacientes con síndrome de Leriche y circulación colateral desde las arterias mamarias a las femorales homolaterales (AU)

Frequently, both peripheral and coronary artery disease are present in the same patient. In patients with abdominal aortic occlusion (i.e., Leriche's syndrome) or femoroiliac occlusion, collateral circulation to the lower extremities can originate in branches of the abdominal aorta or even in the internal thoracic artery (depending on the level of the occlusion). It is important to identify the origin of this circulation during diagnostic procedures, especially in patients who may need to undergo coronary revascularization surgery since, in cases where the majority of the collateral circulation originates in the internal thoracic artery, using the artery as a coronary graft could lead to acute ischemia of the lower extremities. We present three patients with Leriche's syndrome in whom the internal thoracic artery was the origin of the collateral circulation to the ipsilateral femoral artery (AU)