Search Results (154)

Background: Minimally invasive cardiac surgery (MICS) via right minithoracotomy is a safe, reproducible approach with excellent outcomes and reduced costs compared to median sternotomy. Despite careful patient selection, conversion to sternotomy occurs in 1–3% of cases and is associated with significantly higher morbidity and mortality. Small body habitus, particularly a short anteroposterior (AP) diameter, may increase the risk of conversion, but this has not been previously studied. This study aims to identify preoperative factors associated with conversion to improve patient selection for MICS. As cardiovascular surgery becomes increasingly personalized, identifying anatomical factors that predict technical complexity is essential. Methods: This retrospective study included 254 adult patients who underwent elective MICS between 2015 and 2024 at a tertiary hospital. Patient characteristics, computed tomography (CT) scans, intraoperative parameters, and postoperative outcomes were reviewed. AP diameter was defined as the distance from the posterior sternum to the anterior vertebral body at the mitral valve level on CT. Statistical analyses included Mann−Whitney and Fisher’s exact/chi-square tests. Results: Conversion to sternotomy occurred in 1.6% of patients (n = 4). All converted patients were female. The converted group had a significantly shorter median AP diameter (100 mm vs. 124 mm, p = 0.020). Conversion was associated with higher rates of stroke and infection (25.0% vs. 0.8%, p = 0.047 for both), but no significant differences in hospital stay, bleeding, or renal failure. Conclusions: An AP diameter of less than 100 mm was associated with a higher risk of conversion to sternotomy in MICS. Incorporating simple, reproducible preoperative imaging metrics into surgical planning may advance precision-guided cardiac surgery and optimize patient outcomes. Full article

Objective: To test for in-hospital mortality and complication rates in a population-based group of patients with vs. without a history of heart valve replacement undergoing radical prostatectomy (RP). Methods: Relying on the National Inpatient Sample (2000–2019), prostate cancer patients undergoing RP were stratified according to the presence or absence of heart-valve replacement. Multivariable logistics and Poisson regression models addressed adverse hospital outcomes. Results: Within the NIS, 220,358 patients underwent RP. Of those, 694 (0.3%) had a history of heart valve replacement. The patients undergoing heart valve replacement were older (median age 66 vs. 62 years). The proportion of patients with a history of heart valve replacement increases with the Charlson Comorbidity Index (CCI): CCI 0–0.3%, CCI 1–0.4%, and CCI ≥ 2–0.7%. Patients with a history of heart valve replacement exhibited higher rates of postoperative bleeding (<1.5% vs. <0.1%; odds ratio (OR) 16.2; p < 0.001), cardiac complications (7.5% vs. 1.2%; OR 3.9; p < 0.001), infections (<1.5% vs. 0.1%; OR 3.7; p = 0.01), critical care therapy (CCT) use (<1.5% vs. 0.4%; OR 2.5; p = 0.003), intraoperative complications (8.8% vs. 4.1%; OR 1.9; p < 0.001), transfusions (11% vs. 7.2%; OR 1.5; p < 0.001), longer hospital stay (mean 3.39 vs. 2.37 days; rates ratio [RR] 1.4; p < 0.001), and higher estimated hospital cost (median 33,539 vs. 30,716 $USD; RR 1.1; p < 0.001). Conversely, no statistically significant differences were observed in vascular complications (p = 0.3) or concerning in-hospital mortality (p = 0.1). Conclusions: After RP, patients with a history of heart valve replacement exhibited a higher rate of eight out of nine adverse in-hospital outcomes. However, these differences did not translate into higher in-hospital mortality. Full article

Background/Objectives: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is a key approach for treating degenerated surgical bioprosthetic valves. The ACURATE neo2 valve, with its advanced sealing technology and optimized coronary access, represents a promising solution for the challenges of ViV TAVI. This study evaluates the procedural and 30-day and 1-year follow-up outcomes of the ACURATE neo2 valve in ViV TAVI. Methods: This single-center, single-operator prospective study included patients with symptomatic bioprosthetic valve dysfunction, classified in New York Heart Association (NYHA) class III or IV, who underwent ViV TAVI with ACURATE neo2 at our center between July 2022 and February 2024. Outcomes were assessed using VARC-3 criteria. Results: Fifty-five patients (51% females, median (IQR) age 76 (8) years) were included. The technical success rate was 98.2%. No patients experienced in-hospital mortality, stroke, MI, bleeding, vascular complications, renal failure, or new pacemaker implantation. Three patients (5.5%) underwent elective chimney stenting for coronary protection. The postprocedural mean aortic gradient was 6.7 ± 1 mmHg, with a mean aortic valve area (AVA) of 2.0 ± 0.1 cm². Over a median follow-up period of 1.2 years, no deaths (0%) were observed, heart failure hospitalization rate was 3.6%, and NYHA class improved to ≤II in 100% of patients. Conclusions: ACURATE neo2 demonstrated excellent technical success, sustained hemodynamic performance, and significant clinical improvement in ViV TAVI. The absence of major adverse events reinforces its safety, efficacy, and durability as a treatment for degenerated surgical bioprostheses. Full article

Background/Objectives: After years of work in the field of aortic arch surgery, the technique has evolved, making this procedure relatively safe, with lasting results. Due to the increasing long-term survival and overall aging of the patient population, more patients require aortic arch reoperation. In the present study, the safety of aortic arch reoperations was analyzed in the long term, focusing on risk factors for mortality. Methods: Between 1999 and 2023, 108 patients were included in our study who underwent reoperation on aortic arch after prior operation on the aorta, the aortic valve, or a combination of both. The exclusion criteria were being aged under 18 years and transcatheter aortic valve implantation as a previous intervention. The principal outcome was the incidence of mortality, and additional outcomes of interest included cardiac re-reoperation, bleeding, a new aortic type B dissection, infective endocarditis, readmission due to a cardiac cause, coronary intervention and neurovascular complications, pacemaker implantation, and temporary mechanical circulatory support. Results: The mean age was 56 ± 14 years, and 75% (81/108) of patients were male. In our study, we found age (p ≤ 0.01) and history of coronary artery disease (p = 0.01) to be preoperative risk factors for adverse outcomes. The mean time between the index operation and reoperation was 6.84 years (1.61–14.94). Indications for reoperation included dilatation (HR = 0.49, p = 0.05), rupture or false aneurysm (HR = 2.08, p= 0.08), dissection (HR = 1.41, p = 0.30), and endocarditis (HR = 1.49, p = 0.41). A main risk factor was the need for a salvage reoperation (p ≤ 0.01). Also, a longer operation (p = 0.04), cardiopulmonary bypass (p ≤ 0.01), and ventilation time (p ≤ 0.01), bleeding complications (p ≤ 0.01), and requiring temporary mechanical circulatory support (p = 0.04) were linked to higher mortality. The overall survival was 82% after 1 year, 73% after 5 years, and 56% after 10 years. In the multivariate Cox regression analysis, age (HR = 1.04, p ≤ 0.01), the need for a salvage operation (HR = 5.38, p = 0.01), a prolonged ventilation time (HR = 1.08, p = 0.04), and bleeding complications (HR = 3.76, p = 0.03) were associated with higher mortality. In the ROC analysis, an age over 57.5 years was associated with significantly lower overall survival (p ≤ 0.01). Conclusions: Aortic arch reoperations can be performed with acceptable long-term outcomes, but perioperative factors significantly influence early mortality. Salvage operations, bleeding complications, and prolonged ventilation were strong predictors of adverse outcomes. Older age, particularly >57.5 years, was independently associated with increased mortality risk. Full article

Background/Objectives: Although there is a general consensus that patients should have dental evaluation before heart valve surgery, data on the extent and complications of this evaluation are scarce. The objective was to analyze safety and feasibility of dental evaluation in patients undergoing heart valve surgery. Methods: A retrospective chart review of patients referred for dental evaluation prior to heart valve surgery in 2021–2023 was conducted. Demographic, medical, and dental data were recorded. The number and type of dental procedures and their complications were recorded, along with the number of appointments and the time required to achieve dental clearance for heart valve surgery. Results: One hundred and fifty-three patients were referred in the observed period. The predominant procedure was tooth extraction, accounting for 76 (49.7%) cases. Complications were recorded in 3 (1.9%) patients, with delayed bleeding being the most prevalent issue, occurring in 2 (1.3%) patients. The median time required to obtain dental clearance for cardiosurgical procedure was 1 day, with 124 (81%) patients obtaining clearance in a single appointment. No dental emergencies were observed during hospital admission for the cardiosurgical procedure. Conclusions: Our results suggest that dental evaluation before heart valve surgery can be conducted in a reasonable amount of time with a low complication rate and without the need to delay cardiosurgical procedures. Full article

Background: Right ventricular primary graft dysfunction (RV-PGD) is a rare but serious complication following heart transplantation, associated with a high morbidity and mortality. Temporary mechanical circulatory support is indicated when patients fail to respond to pharmacological therapy. This study aimed to evaluate the outcomes of patients with RV-PGD who received RV mechanical support with the Impella RP Flex device at our institution. Methods: Medical records of patients with RV-PGD supported by the Impella RP Flex device between December 2022 and March 2024 were reviewed retrospectively to assess survival, procedural complications, duration of support, and end organ dysfunction. Results: Of the 20 patients reviewed, 5 met the inclusion criteria. All five patients demonstrated recovery of RV function after a mean support duration of 8.6 ± 3.05 days. One pump showed transient evidence of biologic material ingestion during a weaning trial. No cases of tricuspid valve injury were observed. The most common complications were hemolysis, bleeding, and acute kidney dysfunction, with all patients requiring hemodialysis. Conclusions: Impella RP Flex support is safe and effective for managing primary and isolated RV-PGD without the need for additional blood oxygenation. However, bleeding complications requiring intervention remain a significant concern, and further evaluation of renal recovery is warranted. Full article

Aims: This study aimed to evaluate whether the pan-immune inflammation value (PIV) has prognostic value for major adverse cardiac events (MACEs), including stroke, rehospitalization, and in-hospital and one-year all-cause mortality, in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 152 patients undergoing TAVI were retrospectively analyzed and stratified into two groups based on a PIV cutoff value of 488. Baseline clinical, laboratory, echocardiographic, and procedural characteristics were compared. Clinical outcomes, including mortality, cerebrovascular events, and bleeding complications, were assessed. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify independent mortality predictors and evaluate the predictive performance of PIV. Results: Among the 152 patients (mean age 77 ± 7 years; 59.9% female), 52 (34.2%) had a PIV ≥ 488. These patients had significantly higher rates of diabetes mellitus (62% vs. 38%, p = 0.006), chronic kidney disease (31% vs. 12%, p = 0.005), and chronic obstructive lung disease (31% vs. 15%, p = 0.022), along with higher STS scores (16.3 vs. 11.7, p = 0.003). Inflammatory markers were elevated, and lymphocyte and hemoglobin levels were reduced in the high PIV group (p < 0.001). Patients with PIV ≥ 488 experienced significantly higher one-year mortality (58% vs. 4%, p < 0.001), in-hospital mortality (21% vs. 2%, p < 0.001), rehospitalization (29% vs. 4%, p < 0.001), ischemic cerebrovascular events (12% vs. 4%, p < 0.001), and major bleeding (10% vs. 2%, p = 0.034). Multivariable analysis identified age (OR: 1.108; 95% CI: 1.010–1.217; p = 0.031) and PIV (OR: 1.006; 95% CI: 1.003–1.008; p < 0.001) as independent mortality predictors. The PIV showed a strong predictive performance (AUC: 0.90, p < 0.001), with 88% sensitivity and 81% specificity. Kaplan–Meier analysis showed significantly lower survival in the high PIV group (p < 0.001). Conclusions: A high preprocedural PIV is an independent predictor of MACEs, in-hospital, and one-year mortality in AS patients undergoing TAVI. Full article

Objective: Over the last ten years, aortic surgery has transitioned from a high-risk procedure to a well-established operation, offering favorable outcomes and survival when performed by experienced hands. Advances in surgical techniques and evolving technologies allow treatment of older and more complex patients with reoperations. However, outcome data are limited. This study aims to identify risk factors for adverse outcomes after reoperation on the aortic root. Methods: This retrospective study included patients who received aortic root reoperation from 1999 to 2023 in a high-volume center, with a history of previous surgery on the thoracic aorta or aortic valve. Patients under the age of 18 or those with transcatheter aortic valve implantation as an index procedure were excluded. Results: A total of 192 patients were analyzed. Mean age was 57 ± 13 years, and 77.6% were men. The main procedure was Bentall (88.5%). An elective operation was performed in 54.7% of the patients. The mean time between the index operation and reoperation was 8.61 (3.01–16.05) years. Mortality at 30 days was 13%. Survival rates at one, five, and ten years were 84%, 81%, and 71%, respectively. Female gender, non-elective surgery, concomitant procedures, and combined procedures on the aortic root and arch were associated with worse survival. In the Cox regression, age (HR = 3.98, p < 0.01), EuroSCORE II (HR = 1.46, p < 0.01), concomitant procedures at reoperation (HR = 2.53, p = 0.01), prolonged cardiopulmonary bypass time (HR = 1.01, p < 0.01), bleeding complications (HR = 6.11, p < 0.01), and need for temporary mechanical circulatory support (HR = 4.86, p = 0.01) were significantly associated with a higher mortality. Analysis of the receiver operating characteristic curve revealed that age > 60 years at reoperation is a strong predictor for poor outcomes (AUC = 0.712, p < 0.01). Conclusions: Mortality following aortic root reoperation is primarily driven by baseline patient risk and perioperative complications. Reduced survival was observed in patients over 60 years of age, females, those having non-elective surgery, combined root and arch operations, and procedures with additional concomitant operations. Bleeding events, the use of temporary mechanical circulatory support, and concomitant interventions at reoperation emerged as independent predictors of mortality. Full article

Background/Objectives: Oral anticoagulation therapy (OAC) is crucial for reducing the risk of ischemic complications in patients with atrial fibrillation (AF). However, OAC also increases the risk of major bleeding events. The optimal management of OAC in patients with AF undergoing transaortic valve implantation (TAVI) is unclear. This study aimed to compare the efficacy and safety of OAC interruption vs. continuation in patients with AF scheduled for TAVI. Methods: PubMed, EMBASE, and Cochrane were searched to include all pertinent randomized and observational studies. The primary endpoint was the occurrence of net adverse clinical events (NACE), a composite of all-cause death, major vascular complications, and major bleeding at 30-day follow-up. Secondary endpoints included all-cause death, cardiovascular death, major vascular complications, major bleeding, any bleeding, stroke, non-fatal myocardial infarction, and the need for red-packed blood transfusion. Results: A total of three studies and 2773 patients were included in the analysis (1314 were allocated to continuation of OAC therapy and 1459 to interruption of OAC therapy during TAVI). The two study groups experienced a similar rate of NACE (OR = 0.89 [95% CI 0.61 to 1.31], I² = 77%, p = 0.56) compared to the OAC-interruption group. No significant differences were observed in the rate of all-cause death (p = 0.21), cardiovascular death (p = 0.35), major vascular complications (p = 0.84), major bleeding events (p = 0.47), total bleeding events (p = 0.62), or non-fatal MI (p = 0.55). Interestingly, the OAC-continuation group experienced a lower occurrence of stroke (OR = 0.62 [95% CI 0.39 to 0.97], I² = 0%, p = 0.04) and the need for red packed blood cells (OR = 0.66 [95% CI 0.50 to 0.86], I² = 20%, p < 0.01) compared to the OAC-interruption group. Conclusions: In patients with AF undergoing TAVI, there was no significant difference between interruption and continuation of OAC in terms of NACE, composite of all-cause death, major vascular complications, or major bleeding at 30-day follow-up. Of interest, the OAC-continuation group patients experienced lower rates of stroke and the need for blood transfusion. Full article

Background: Infective endocarditis continues to represent a challenge for healthcare systems, requiring careful management and resources. Recent studies have indicated a shift in the predominant pathogens of concern, with Streptococcus sp. a being superseded by Staphylococcus sp. and Enterococcus sp. as the leading causes of concern. This shift is of concern as it is associated with Staphylococcus Aureus which has a high virulence rate and a tendency to form a biofilm, meaning that non-surgical therapy may not be effective. It is imperative to deliberate on the likelihood of platelet blood clot formation, which may be accompanied by bacterial infestation and the development of a biofilm. Methods: MEDLINE, Embase, and Pubmed were searched using terms relating to ‘endocarditis’ and ‘Staphilococcus aureus’, along with ‘epidemiology’, ‘pathogenesis’, ‘coagulation’, ‘platelet’, ‘aggregation’, and ‘immunity’. The search focused on publications from the past 15 years, but excluded older, highly regarded articles. We also searched the reference lists of relevant articles. Recommended review articles are cited for more details. Results: An endocarditis lesion is believed to be a blood clot infected with bacteria that adheres to the heart valves. Infective endocarditis is a good example of immunothrombosis, where the coagulation system, innate immunity and the function of coagulation in isolating and eliminating pathogens interact. However, in the context of infective endocarditis, immunothrombosis unintentionally establishes an environment conducive to bacterial proliferation. The process of immunothrombosis impedes the immune system, enabling bacterial proliferation. The coagulation system plays a pivotal role in the progression of this condition. Conclusion: The coagulation system is key to how bacteria attach to the heart valves, how vegetations develop, and how complications like embolisation and valve dysfunction occur. Staphylococcus aureus, the main cause of infective endocarditis, can change blood clotting, growing well in the fibrin-rich environment of vegetation. The coagulation system is a good target for treating infective endocarditis because of its central role in the disease. But we must be careful, as using blood-thinning medicines in patients with endocarditis can often lead to an increased risk of bleeding. Full article

Background/Objectives: Patients with atrial fibrillation and mitral regurgitation (MR) undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) often have concomitant indications for left atrial appendage occlusion (LAAO), mandating a more personalized treatment approach. This study aimed to examine the effectiveness and safety of combining M-TEER/LAAO in one procedure. Methods: MEDLINE (PubMed), Scopus, and Cochrane were searched through 21 March 2025 for studies examining M-TEER/LAAO with or without control (M-TEER only). Double-independent study selection, extraction, and quality assessments were performed. Frequentist random-effects models were used to calculate mean differences (MDs) and risk ratios (RRs) with 95% confidence intervals (CIs). Results: Seven studies (223 participants) were included. For M-TEER/LAAO, the mean procedural time was 101.6 min (95% CI = [85.06, 118.13]), the mean radiation time was 29.97 min (95% CI = [23.85, 36.09]), the mean length of stay was 5.21 days (95% CI = [3.31, 7.12]), procedural success was achieved in 89.5% of cases (95% CI = [73.4, 96.3], and post-procedure MR > 2+ occurred in 14.8% of cases (95% CI = [3.6, 44.5]). Compared to M-TEER only, patients with M-TEER/LAAO had similar procedural (RR = 0.91, 95% CI = [0.71, 1.17]) and technical success (RR = 1, 95% CI = [0.94, 1.06]) with a similar risk of acute kidney injury (RR = 1, 95% CI = [0.07, 15.12]), bleeding (RR = 0.40, 95% CI = [0.01, 18.06]), and all-cause death (RR = 0.59, 95% CI = [0.22, 1.54]). M-TEER/LAAO was non-significantly associated with in-hospital death (RR = 3, 95% CI = [0.13, 70.23]), stroke (RR = 3, 95% CI = [0.13, 70.23]), and vascular complications (RR = 1.55, 95% CI = [0.43, 5.59]) compared to M-TEER only. Most patients (34.2%, 95% CI = [2.8, 90.4]) received dual antiplatelet therapy at discharge, followed by anticoagulation only (20.2%, 95% CI = [7.5, 44.3]). Conclusions: M-TEER/LAAO can be combined into a single procedure with good peri-procedural outcomes. Safety was also satisfactory; however, some concerns may arise regarding in-hospital death, stroke, and vascular complications. Further research is needed to explore the effectiveness and safety of this combined strategy and elucidate the risk–benefit profile of this personalized treatment approach. Full article

Background/Objectives: Aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries and imposes an increasing burden on aging populations. Although transcatheter aortic valve implantation (TAVI) has transformed the treatment of severe AS, current guidelines do not differentiate management based on gender. This study aimed to investigate gender-based differences in procedural complications and one-year clinical outcomes in patients treated with next-generation self-expandable TAVI devices. Methods: This retrospective, multicenter international registry included 3862 consecutive patients who received either the ACURATE neo or Evolut R/Pro valve. Patients were stratified by gender; propensity score matching (PSM) adjusted for baseline differences. The primary endpoint was a composite of all-cause mortality or stroke at one year. Secondary endpoints included major vascular complications, major or life-threatening bleeding and acute kidney injury (AKI). Results: Of 3353 patients included (64.5% female), women were older (82.3 ± 5.6 vs. 81.1 ± 6.2 years, p < 0.001) and had higher STS scores (5.2 ± 3.9 vs. 4.5 ± 3.4%, p < 0.001). In the unmatched population, major vascular complications occurred in 7.7% of females versus 4.1% of males (p < 0.001), life-threatening bleeding in 2.8% vs. 1.4% (p = 0.016) and AKI in 8.5% vs. 5.7% (p = 0.009). After PSM, the primary endpoint was more frequent in females (9.4% vs. 6.0%, p = 0.014), largely driven by stroke (2.8% vs. 1.2%, p = 0.024), while overall mortality was similar (11.3% vs. 9.5%, p = 0.264). Conclusions: Despite comparable long-term survival, female patients undergoing TAVI with self-expandable valves experience higher rates of procedural complications, notably stroke and major vascular events. These findings underscore the need for tailored procedural strategies to improve outcomes in female patients. Full article

Background: Heyde syndrome is a rare condition characterized by the triad of severe aortic stenosis, gastrointestinal bleeding, and acquired type 2A von Willebrand syndrome. This case report highlights the diagnostic and therapeutic approach for a 72-year-old woman presenting with exertional chest pain, dyspnea, fatigue, and a history of melena. Methods: The diagnostic workup revealed severe microcytic anemia and a reduced vWF ristocetin-to-antigen ratio. Imaging confirmed severe degenerative aortic stenosis, while video capsule endoscopy identified angiodysplasia and telangiectasias in the small bowel as the source of gastrointestinal bleeding. Following evaluation by a multidisciplinary Heart Team, the patient underwent transcatheter aortic valve replacement (TAVR) with an Evolut Fx self-expanding prosthesis. Results: Post-procedural echocardiography showed mild paravalvular regurgitation. The patient’s clinical course was favorable, with resolution of anemia and no further gastrointestinal bleeding episodes. Conclusions: Heyde syndrome requires a high index of suspicion for diagnosis in patients with severe aortic stenosis and unexplained anemia or gastrointestinal bleeding. TAVR offers an effective treatment option that not only resolves valvular pathology, but also mitigates associated bleeding risks. Full article

Background: Atrial fibrillation (AF) is prevalent in patients undergoing transcatheter aortic valve replacement (TAVR). However, the optimal antithrombotic strategy tailored to individual patient profiles remains unclear. This study aims to evaluate the outcomes of personalized antithrombotic regimens in patients with AF after TAVR. Methods: We enrolled 121 AF patients who underwent TAVR from 2009 to 2023. Patients were grouped into seven groups based on individualized post-procedural antithrombotic regimens. The regimens included the following: single antiplatelet therapy (SAPT) + direct oral anticoagulant (DOAC) (n = 44, 36.3%); DOACs only (n = 25, 20.6%), SAPT + warfarin (n = 17, 14%); dual antiplatelet therapy (DAPT) (n = 13, 10.7%); warfarin only (n = 8, 6.6%); DAPT + warfarin (n = 7, 5.8%); and DAPT + DOACs (n = 7, 5.8%). The study outcomes included incidences of strokes or transient ischemic attacks (TIAs), major bleeding, and survival. Results: The median follow-up was 27 months. The incidence of stroke, TIA, or major bleeding was similar among the seven treatment groups. However, a trend toward a higher rate of stroke was observed in the triple regimen containing warfarin (28.6%); also, the highest rate of major bleeding was observed in the warfarin-only group (25%). Survival for patients discharged and placed under various antithrombotic regimens did not differ significantly despite some numerical variations being present across the groups, with the lowest mortality reported with SAPT + warfarin (7%) and the highest with DAPT + warfarin (57%). Conclusions: This study highlights the outcomes related to stroke, major bleeding, and mortality across personalized antithrombotic regimens in patients with AF after TAVR. While no statistically significant differences were observed, findings emphasize the need for further large-scale studies to define optimal personalized antithrombotic strategies based on individual patient characteristics. Full article

A periprocedural prosthetic valve leak (PVL) after transcatheter aortic valve implantation (TAVI), a minimally invasive treatment modality for patients with severe, symptomatic aortic stenosis, may entail serious morbidity. Cohorts hospitalized for TAVI from a national database (2016–2020) were stratified on the presence of PVL post-TAVI. TAVI patients with and without PVL were selected for propensity score matching. Pearson’s x² test was used to compare outcomes. Among 319,448 TAVI patients over five years, 2043 had periprocedural PVL identified at index hospitalization, acute heart failure (49.61% vs. 41.15%, p < 0.001), acute kidney injury (20.40% vs. 11.77%, p < 0.001), cardiac tamponade (1.31% vs. 0.52%, p < 0.05), higher inpatient mortality (3.05% vs. 1.05%, p < 0.001), postprocedural bleeding (3.5% vs. 1.48%, p < 0.001), sudden cardiac arrest (15.34% vs. 8.54%, p < 0.001), and vascular complications (4.10% vs. 1.57%, p < 0.001). TAVI with PVL was associated with a significantly longer length of stay (p < 0.05) and total cost of hospitalization (p < 0.05). The 30-day (15.2% vs. 12%, p = 0.02), 90-day (24.4% vs. 19.9%, p < 0.01), and 180-day (34.7% vs. 24.8%, p < 0.01) readmission rates were significantly higher in the TAVI cohort with PVL. PVL in patients post-TAVI is associated with greater mortality and morbidity during index hospitalization, higher readmission rates, and increased burden on healthcare costs and infrastructure. Full article