Viraj Bhise

Prevalence of Subclinical Hypothyroidism in Patients with End-Stage Renal Disease and the Role of Serum Albumin: A Cross-Sectional Study from South India

Background/Aim: Subclinical hypothyroidism (SCH) and end-stage renal disease (ESRD) are independent risk factors for cardiovascular mortality. We aimed to study the prevalence of SCH in ESRD patients and assessed its associated risk factors. Methods: This cross-sectional study was conducted at 2 tertiary-care centers in Chennai, India, over a 3-year period. The study group comprised 137 patients with ESRD on thrice weekly regular maintenance hemodialysis. Free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured using an electrochemiluminescence immunoassay. SCH was defined as TSH ranging between 4.5 and 10 mIU/l with normal FT4 (0.93–1.7 ng/dl). Patients with overt hypothyroidism, SCH and overt hyperthyroidism, those on medications affecting thyroid function and pregnant women were excluded from the study. Results: Of 137 ESRD patients (mean age: 43 ± 13.38 years), 107 were males (78.1%), 45 diabetics (32.8%), 127 hypertensives (92.7%), and 38 smokers (27.7%). Prevalence of SCH was 24.8%. In unadjusted (OR: 3.37, 95% CI: 1.91–5.21) and adjusted (for age, gender, HbA1C, and albumin/creatinine ratio; OR: 3.11, 95% CI: 2.15–4.98) logistic regression analysis, serum albumin was significantly associated with SCH. Further, multiple linear regression identified that for every 1 g/dl drop in serum albumin TSH increased by 4.61 mIU/l (95% CI: 2.75–5.92). Conclusion: We observed a high prevalence of SCH in our ESRD patients. Also, serum albumin was significantly associated with SCH in our study.

Early readmissions after transcatheter and surgical aortic valve replacement

We aimed to determine and compare the prevalence, and predictors of readmissions after the transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR).

Transcatheter and Surgical Aortic Valve Replacement in Patients With End-Stage Renal Disease

Data on comparative outcomes and readmissions after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with end-stage renal disease (ESRD) are scarce because these patients were excluded from major TAVR trials [(1)][1]. We conducted retrospective

TCT-724 Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement – National Experience

METHODS We enrolled 231 consecutive pts who underwent successfully transfemoral TAVI in local anesthesia using the ESV-3 valve (23,26,29mm). CT-imaging including the Heart Navigator algorithm was used for prosthesis size and implantation plane selection. Serving the mid-balloon marker as reference, 107 pts underwent deep implantation (0.5, 500/o of the crimped valve above annulus level), 124 underwent high implantation (0.6-0.7, 60-70% of the crimped valve above annulus level). Clinical events and post-TAVI PVL was evaluated after 30 days and one year according to the VARC-II criteria.

Risk Prediction Model for Permanent Pacemaker Implantation after Transcatheter Aortic Valve Replacement

ABSTRACT Background: Atrioventricular conduction disturbance requiring permanent pacemaker (PPM) implantation is the most common complication after transcatheter aortic valve replacement (TAVR). Improved risk stratification for potential need for post-procedure PPM implant prior to the TAVR procedure is warranted. The aim of this study was to develop and validate a risk-prediction model for PPM implantation after TAVR. Methods: This PPM risk assessment model was developed using the 2012&2013 National Inpatient Sample (NIS). A logistic regression model was built to identify the predictors of PPM placement. The performance of the model was validated using the NIS 2014 dataset. Results: Of 18,400 patients in the development cohort, 1,825 (9.9%) patients required PPM implantation after TAVR. After multivariate analysis, final predictive covariates of PPM implantation included left or right bundle branch block, bradycardia, 2nd-degree AV block and transfemoral approach. The estimated regression coefficients associated with these predictors were used to develop a scoring system. The proposed scoring system showed good discrimination in both development and validation cohorts, with c-statistics of 0.754 (95% CI: 0.726–0.782) and 0.746 (95% CI: 0.721–0.772) respectively. Calibration analysis indicated a good agreement between the observed rate of PPM and predicted risks of PPM by the risk score. Conclusions: This PPM risk prediction model derived using the NIS database is a simple tool that can estimate individual risk of PPM prior to TAVR procedure. The model displayed good discrimination and calibration indices. This risk score can provide valuable information for patients’ counseling and also help identify high-risk patients who need close monitoring immediately after the TAVR procedure.

Outcomes and readmissions after transcatheter and surgical aortic valve replacement in patients with cirrhosis: A propensity matched analysis

The data on the comparative outcomes and readmissions after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with cirrhosis are limited. We compared mortality, complications, discharge disposition, 30‐day readmission rates, length of stay, and cost of hospitalization in cirrhotic patients undergoing TAVR and SAVR.

COMPARING OUTCOMES IN COPD PATIENTS UNDERGOING TAVR AND SAVR: A PROPENSITY MATCHED ANALYSES

Background: Outcomes in patients with severe aortic valve stenosis and chronic obstructive pulmonary disease (COPD) have not been extensively studied in literature. Our objective was to use national data to compare outcomes in patients undergoing transfemoral (TF-TAVR) and surgical aortic valve

TCT-668 Comparison of Early Readmissions after Transcatheter and Surgical Aortic Valve Replacement

RESULTS Over the recommended annulus diameter ranges of the respective THVs, the SAPIEN XT exerted the largest RF (maximum of 147 N) whereas the self-expanding valves presented with a significantly lower RF (maximum of 66 N). As expected, the RF increased with decreasing valve diameter. Self-expanding valves showed a particular behavior known as ‘biased stiffness’. This indicates that the RF depends on the compression-state in which the stent was before deployment and such a phenomenon was not seen with the balloonexpandable valves. In contrast, the SAPIEN XT valve was characterized by a so called ‘stent recoil’, which is a decrease of the valvediameter right after full deployment indicating that the SAPIEN XT displays elastic properties around its maximal diameter. Finally, we observed that a diameter variation of 2mm was associated with significant changes in radial forces, which is of utmost importance in clinical practice avoiding fatal complications such as an annulus perforation.