FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2894904775> ?p ?o ?g. }

• W2894904775 endingPage "530" @default.
• W2894904775 startingPage "528" @default.
• W2894904775 abstract "The evidence to support the optimal strategies for treating patients with acute and severe decompensation of aortic valve stenosis is limited and remains unclear.1Kolte D Khera S Vemulapalli S et al.Outcomes following urgent/emergent transcatheter aortic valve replacement: insights from the STS/ACC TVT registry.JACC Cardiovasc Interv. 2018; 11 (doi: 10.1016/j.jcin.2018.03.002.): 1175-1185Google Scholar, 2Bongiovanni D Kuhl C Bleiziffer S et al.Emergency treatment of decompensated aortic stenosis.Heart. 2018; 104 (doi: 10.1136/heartjnl-2016-311037.): 23-29Google Scholar, 3Alkhouli M, Chaker Z, Cook C, Raybuck B. Emergent transcatheter aortic valve replacement for the treatment of severe aortic stenosis patients presenting with cardiogenic shock or cardiac arrest; a case series. Structural Heart. 2018; 2(6):this issue.Google Scholar, 4Landes U Orvin K Codner P et al.Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure: procedural and 30-day outcomes.Can J Cardiol. 2016; 32 (doi: 10.1016/j.cjca.2015.08.022.): 726-731Google Scholar, 5Frerker C Schewel J Schluter M et al.Emergency transcatheter aortic valve replacement in patients with cardiogenic shock due to acutely decompensated aortic stenosis.EuroIntervention. 2016; 11 (doi: 10.4244/EIJY15M03_03.): 1530-1536Google Scholar, 6Wald DS Williams S Bangash F Bestwick JP Watchful waiting in aortic stenosis: the problem of acute decompensation.Am J Med. 2018; 131 (doi: 10.1016/j.amjmed.2017.08.027.): 173-177Google Scholar Retrospective registry data as well as single center case reports often include heterogeneous patient populations with both urgent and truly emergent indications for transcatheter aortic valve replacement (TAVR). In a retrospective cohort series at five German centers between 2009 and 2015 by Bongiovanni et al,2Bongiovanni D Kuhl C Bleiziffer S et al.Emergency treatment of decompensated aortic stenosis.Heart. 2018; 104 (doi: 10.1136/heartjnl-2016-311037.): 23-29Google Scholar emergent indications for TAVR were defined as: cardiogenic shock requiring catecholamine therapy, New York Heart Association (NYHA) class IV dyspnea, cardiac resuscitation or mechanical respiratory support. In the emergent TAVR group (n = 23), immediate procedural mortality was 8.7%, compared with 20.3% in the group that only underwent emergent balloon aortic valvuloplasty (BAV) (n = 118, p = 0.19). After 30 days, cardiovascular mortality for the emergent TAVR group was 23.8% and for the emergent BAV group was 33.0% (p = 0.40). Analyses adjusting for potential confounders did not provide evidence of a difference between groups. Interestingly, after a median of 35 days, 32 of the 118 patients in the emergent isolated BAV group underwent elective TAVR; however, immediate procedural mortality remained elevated at 9.4% with a cardiovascular mortality after 30 days of 15.6%. Major vascular complications were 17.4% in the emergent TAVR group and 3.4% in the emergent BAV group (p = 0.01), likely related to older generation devices with larger sheath sizes. Importantly, periprocedural management and mode of anesthesia were at the discretion of the implanting physician and center. Given the above, a contemporary prospective case series to inform practice in this high-risk group was urgently needed. Alkhouli at al. 3Alkhouli M, Chaker Z, Cook C, Raybuck B. Emergent transcatheter aortic valve replacement for the treatment of severe aortic stenosis patients presenting with cardiogenic shock or cardiac arrest; a case series. Structural Heart. 2018; 2(6):this issue.Google Scholar report a prospective single-center consecutive case series of nine patients undergoing emergent TAVR between 2016 and 2018 in the current issue of Structural Heart. The mean age was 80.6 ± 9.9 years with a mean left ventricular ejection fraction of 42.8 ± 19.1%. The indication for emergent TAVR was cardiogenic shock in 6 (67%), cardiac arrest in 2 (22%), and both in 1 (11%). The mean time from event to TAVR time was 9.9 hours (range 2–14 hours). BAV prior to TAVR was utilized in four patients (44%), and periprocedural percutaneous assist devices (Impella CP or Intra-Aortic Balloon Pump) were utilized in three patients (33%). Procedural success was achieved in 100%, and 8/9 patients (89%) survived to discharge. All surviving patients were NYHA class I/II after 30 days with an aortic valve area of 1.5 ± 0.34 cm2 and a mean aortic valve gradient of 11.8 ± 6.4 mmHg with no significant paravalvular leak. The authors are to be commended for their meticulous data collection and excellent outcomes; however, multiple questions remain. Data on patients presenting with cardiogenic shock or cardiac arrest that did not undergo TAVR during the study period were not collected and thus the true denominator remains ambiguous. Data from the United States and Canada indicate that up to 10% of patients undergo TAVR during an unplanned hospitalization with a similar procedural success in elective patients but higher in-hospital morbidity and mortality.1Kolte D Khera S Vemulapalli S et al.Outcomes following urgent/emergent transcatheter aortic valve replacement: insights from the STS/ACC TVT registry.JACC Cardiovasc Interv. 2018; 11 (doi: 10.1016/j.jcin.2018.03.002.): 1175-1185Google Scholar,4Landes U Orvin K Codner P et al.Urgent transcatheter aortic valve implantation in patients with severe aortic stenosis and acute heart failure: procedural and 30-day outcomes.Can J Cardiol. 2016; 32 (doi: 10.1016/j.cjca.2015.08.022.): 726-731Google Scholar Although the number of patients presenting with a truly emergent indication for TAVR is likely lower, it behooves any modern Heart Team to be prepared and have a streamlined clinical pathway in place that can be adapted for emergent patients. Five of the nine patients presented to the Emergency Room but only two underwent emergent TAVR at 8 and 14 hours respectively. The remaining three patients underwent TAVR the following morning although two had a “temporizing” BAV on presentation. Although the decision to perform TAVR is complex and requires shared decision making as well as thoughtful anatomical and functional review, it remains unclear whether a more streamlined approach with immediate emergent TAVR may have further improved outcomes and reduced length of stay (LOS), which ranged from 4 to 12 days in the current cases series. It is important to note that the remaining four patients became unstable during their elective workup for TAVR (elective angiography, elective staged percutaneous intervention, elective computed tomography angiography (CTA), and inpatient pulmonary function testing) and thus any emergent TAVR protocol must be flexible and have the ability to rapidly triage and treat both unstable inpatients and outpatients. The authors note that all cases were performed in the hybrid operating room with percutaneous transfemoral access. Although not specifically stated, it appeared that all patients received general anesthesia. Additional periprocedural management was not detailed. We have previously reported that utilizing the Vancouver Clinical Pathway in elective TAVR patients,7Wood D, Lauck S, Cairns J, et al. The Vancouver multidisciplinary, multimodality, but minimalist clinical pathway facilitates safe next day discharge home at low, medium, and high volume transcatheter aortic valve replacement centres: the 3M TAVR Study. JACC Cardiovasc Interv. 2018. (In Press).Google Scholar which is focused on next-day discharge, with standardized preprocedural, periprocedural, and postprocedural management guidelines, could be safely implemented with excellent clinical (30-day mortality and stroke 1.5%, respectively) and hemodynamic (> mild paravalvular regurgitation 3.8%) outcomes with a high proportion of early discharge (80% within 24 hours and 90% within 48 hours) and a low 30-day cardiac readmission rate (5.7%). This prospective multicenter study of 411 patients at 13 low-, medium-, and high-volume sites demonstrated that the pathway could be safely implemented irrespective of site experience and volume and in new centers with limited prior experience with a rapid reconditioning protocol. We believe the pathway can be easily adapted for patients with an emergent indication for transfemoral TAVR. At the Centre for Heart Valve Innovation (CHVI) in Vancouver, we implemented a “Code TAVR” protocol in 2016 (Figure 1) based on the Vancouver Clinical Pathway. We instigated a formal protocol after a 79-year-old male who had undergone aortic valve replacement (25-mm Mitroflow bioprosthesis, Sorin Group, Milan) and coronary artery bypass graft surgery in 2009 presented to the emergency in refractory cardiogenic shock despite high dose inotropic support.8Quick decision saves man’s life, sets medical record. The Vancouver Sun. Tuesday March 15, 2016; A1 and A6.Google Scholar Angiography and echocardiography confirmed severe transvalvular aortic regurgitation. Considering his risk with repeat surgery, patent LIMA graft to the LAD, and inability to perform effective temporizing mechanical hemodynamic support the Heart Team decided to perform emergent transcatheter aortic valve-in-valve replacement while the patient was awake with no conscious sedation in under 19 minutes. The “Door-to-TAVR” time was under 2½ hours. The above case illustrates what is feasible at an established quaternary care valve center with both a mature Heart Team and flexible Implanting Team. Our experience as well as the case series reported by Alkhouli at al. 3Alkhouli M, Chaker Z, Cook C, Raybuck B. Emergent transcatheter aortic valve replacement for the treatment of severe aortic stenosis patients presenting with cardiogenic shock or cardiac arrest; a case series. Structural Heart. 2018; 2(6):this issue.Google Scholar (current issue) clearly highlight three emerging themes:(1)The Heart Team and Implanting Team are no longer synonymous. Until recently, these two terms have been used interchangeably. We were able to convene an emergency Heart Team meeting over the telephone while the patient remained on the table. All team members had worked closely together for over 10 years and thus when it became clear that the risk for repeat surgery was prohibitive (calculated Society of Thoracic Surgeons (STS) score of 29.7%) and there was no effective means to provide temporizing mechanical hemodynamic support, a consensus was reached in less than 5 minutes. The team on site became the de facto Implanting Team. A risk-stratified approach with a flexible Implanting Team that can deliver timely care in either a hybrid operating room or standard cardiac catheterization laboratory will be crucial as volumes increase.(2)Rapid anatomical and functional screening is now feasible in isolated cases. Although there is general consensus on the appropriate anatomical and functional tests that should be completed prior to formal review by the Heart Team,7Wood D, Lauck S, Cairns J, et al. The Vancouver multidisciplinary, multimodality, but minimalist clinical pathway facilitates safe next day discharge home at low, medium, and high volume transcatheter aortic valve replacement centres: the 3M TAVR Study. JACC Cardiovasc Interv. 2018. (In Press).Google Scholar the above cases illustrate that in some patients this process can be safely truncated. As the Vancouver Clinical Pathway encourages minimal or no procedural sedation, we are able to rapidly determine if a patient is a good functional candidate. Although a screening CTA is usually preferred, the above cases demonstrate that a screening process that normally involves a full day can sometimes be safely accomplished in only minutes. We try to involve both patients and their families in shared decision making; however, in truly emergent cases this is sometimes not feasible.(3)The Implanting Team needs to be self-sufficient. As volumes increase and emergent cases become more common, it is crucial that a quaternary care valve centre has the necessary personnel on site to prepare and implant at least one if not multiple THV platforms. Before a center considers implementing a “Code TAVR” protocol, minimum safety criteria, similar to those required for elective TAVR, should be in place (Figure 1). The Anesthesiology team, Imaging team, and Perfusion team must be available to facilitate conversion to general anesthesia/intubation within 5 minutes, assess for complications and significant paravalvular regurgitation with transthoracic echocardiogram (TTE) or transesophageal echocardiography (TEE) within 5 minutes, and transition to emergent hemodynamic support within 10 minutes if required. We believe the concepts outlined above will gain importance as we transition to a default transfemoral strategy for most patients with failing native and bioprosthetic aortic valves. Although “Code TAVR” and “Door-to-TAVR” time may still be on the horizon at some institutions, we believe we have now entered an era where they should be part of the lexicon at any mature Heart Valve Centre. Drs. Wood, Lauck, and Webb are consultants or receive grant support from Edwards Lifesciences. All remaining authors have reported that they have no relationships relevant to the contents of this paper to disclose." @default.
• W2894904775 created "2018-10-12" @default.
• W2894904775 creator A5024773710 @default.
• W2894904775 creator A5040339119 @default.
• W2894904775 creator A5075242638 @default.
• W2894904775 creator A5079305052 @default.
• W2894904775 date "2018-11-01" @default.
• W2894904775 modified "2023-10-01" @default.
• W2894904775 title "Have We Entered the Era of “Code TAVR” and “Door-to-TAVR” Time?" @default.
• W2894904775 cites W11073838 @default.
• W2894904775 cites W1260678629 @default.
• W2894904775 cites W2619571451 @default.
• W2894904775 cites W2755070735 @default.
• W2894904775 cites W2794369231 @default.
• W2894904775 cites W2887628364 @default.
• W2894904775 cites W2919976021 @default.
• W2894904775 doi "https://doi.org/10.1080/24748706.2018.1521029" @default.
• W2894904775 hasPublicationYear "2018" @default.
• W2894904775 type Work @default.
• W2894904775 sameAs 2894904775 @default.
• W2894904775 citedByCount "0" @default.
• W2894904775 crossrefType "journal-article" @default.
• W2894904775 hasAuthorship W2894904775A5024773710 @default.
• W2894904775 hasAuthorship W2894904775A5040339119 @default.
• W2894904775 hasAuthorship W2894904775A5075242638 @default.
• W2894904775 hasAuthorship W2894904775A5079305052 @default.
• W2894904775 hasBestOaLocation W28949047751 @default.
• W2894904775 hasConcept C164705383 @default.
• W2894904775 hasConcept C177264268 @default.
• W2894904775 hasConcept C199360897 @default.
• W2894904775 hasConcept C2776760102 @default.
• W2894904775 hasConcept C2780007028 @default.
• W2894904775 hasConcept C2780026749 @default.
• W2894904775 hasConcept C41008148 @default.
• W2894904775 hasConcept C71924100 @default.
• W2894904775 hasConceptScore W2894904775C164705383 @default.
• W2894904775 hasConceptScore W2894904775C177264268 @default.
• W2894904775 hasConceptScore W2894904775C199360897 @default.
• W2894904775 hasConceptScore W2894904775C2776760102 @default.
• W2894904775 hasConceptScore W2894904775C2780007028 @default.
• W2894904775 hasConceptScore W2894904775C2780026749 @default.
• W2894904775 hasConceptScore W2894904775C41008148 @default.
• W2894904775 hasConceptScore W2894904775C71924100 @default.
• W2894904775 hasIssue "6" @default.
• W2894904775 hasLocation W28949047751 @default.
• W2894904775 hasOpenAccess W2894904775 @default.
• W2894904775 hasPrimaryLocation W28949047751 @default.
• W2894904775 hasRelatedWork W1488252555 @default.
• W2894904775 hasRelatedWork W2121399917 @default.
• W2894904775 hasRelatedWork W2166973706 @default.
• W2894904775 hasRelatedWork W2791327883 @default.
• W2894904775 hasRelatedWork W2799776432 @default.
• W2894904775 hasRelatedWork W2918458441 @default.
• W2894904775 hasRelatedWork W3195110471 @default.
• W2894904775 hasRelatedWork W3206737196 @default.
• W2894904775 hasRelatedWork W4256536752 @default.
• W2894904775 hasRelatedWork W4296462422 @default.
• W2894904775 hasVolume "2" @default.
• W2894904775 isParatext "false" @default.
• W2894904775 isRetracted "false" @default.
• W2894904775 magId "2894904775" @default.
• W2894904775 workType "article" @default.