Hope Caughron

Readmission rates after transcatheter aortic valve replacement in high- and extreme-risk patients with severe aortic stenosis

Objective In high‐ or extreme‐risk patients undergoing transcatheter aortic valve replacement, readmissions have not been adequately studied and are the subject of increased scrutiny by healthcare systems. The objectives of this study were to determine the incidence of 30‐day and 1‐year cardiac and noncardiac readmissions, identify predictors of readmission, and assess the association between readmission and 1‐year mortality. Methods A retrospective review was performed on 714 patients who underwent transcatheter aortic valve replacement from September 2007 to January 2015 at Emory University. Results Patients’ median age was 83 years, and 46.6% were female. Early all‐cause readmission for the cohort was 10.5%, and late readmission was 18.8%. Anemia was related to both early all‐cause (hazard ratio [HR], 0.74) and cardiovascular‐related readmission (HR, 0.60). A 23‐mm valve implanted was associated with early all‐cause readmission (HR, 1.73). Length of hospital stay was related to late all‐cause (HR, 1.14) and cardiovascular‐related readmission (HR, 1.21). Postoperative permanent stroke had an impact on late cardiovascular‐related readmission (HR, 3.60; 95% confidence interval, 1.13‐11.49). Multivariable analysis identified anemia as being associated with 30‐day all‐cause readmission, and anemia and postoperative stroke were associated with 30‐day cardiovascular‐related readmission. Readmissions seemed to be related to 1‐year mortality (HR, 2.04; 95% confidence interval, 1.33‐3.12). Conclusions We show some baseline comorbidities and procedural complications that are directly associated with early and late readmissions, and anemia and postoperative stroke were associated with an increase in mortality. Moreover, we found that readmission was associated with double the hazard of death within 1 year. Whether treatment of identified risk factors could decrease readmission rates and mortality warrants further investigation.

Does minimalist transfemoral transcatheter aortic valve replacement produce better survival in patients with severe chronic obstructive pulmonary disease

To compare outcomes after minimalist and standard transfemoral transcatheter aortic valve replacement (TF‐TAVR) in patients with severe chronic obstructive pulmonary disease (COPD).

REPEAT PULMONARY VALVE REPLACEMENT: SIMILAR INTERMEDIATE-TERM OUTCOMES BETWEEN SURGICAL AND TRANSCATHETER PROCEDURES

There is no previous report comparing clinical or echocardiographic outcomes in patients with a history of prior surgical pulmonary valve replacement (SPVR) who undergo repeat SPVR or transcatheter pulmonary valve replacement (TPVR). We retrospectively identified patients who had previous SPVR and

Mitral Bioprosthetic Valve Fracture: Bailout Procedure for Undersized Bioprosthesis During Mitral Valve-in-Valve Procedure With Paravalvular Leak Closure

A 76-year-old obese man (body mass index 30.8 kg/m2, body surface area 2.35 m2) with a history of mitral valve replacement and coronary artery bypass grafting was admitted to our hospital with decompensated heart failure. The patient underwent surgical mitral valve replacement with a 25-mm Mosaic

Hybrid Closure of Apical Post-Infarct Septal Defect: Externalizing an Occluder and Excluding the Right Ventricle

A 63-year-old man was transferred to our hospital 5 weeks after an acute anterior myocardial infarction complicated by an apical ventricular septal defect (VSD). He was on intravenous dopamine and required an intra-aortic balloon pump for hemodynamic stability. A large peri-infarct area with a

Supra-annular valve strategy for an early degenerated transcatheter balloon-expandable heart valve

Currently, there are no recommendations regarding the selection of valve type for a transcatheter heart valve (THV)‐in‐THV procedure. A supra‐annular valve design may be superior in that it results in a larger effective orifice area and may have a lower chance of valve thrombosis after THV‐in‐THV. In this report, we describe the use of a supra‐annular valve strategy for an early degenerated THV.

MINIMALIST VERSUS STANDARD TRANSFEMORAL TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH SEVERE CHRONIC OBSTRUCTIVE LUNG DISEASE

Transfemoral (TF) transcatheter aortic valve replacement is increasingly performed with conscious sedation and transthoracic echo guidance in the cath lab (Minimalist, MA-TAVR). We studied whether MA-TAVR results in better outcomes than standard TF-TAVR (SA-TAVR) in patients with severe chronic