- Email: [email protected]
TCT-715 Abstract Withdrawn
B290
12 Unknown, Munich, Germany; 13Alfred Hospital; Herzzentrum München, Munich, Germany
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
14
Deutsches
BACKGROUND Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic valve replacement in patients at high operative risk. Multislice computed tomography (MSCT) has emerged as the mainstay in procedural planning. Because of advanced age of patients, incidental radiological findings (IF) in MSCT are common. However, the exact incidence, clinical relevance and further consequences of IF are unclear. Further, it is unknown whether patients’ outcome is adversely affected by IF. METHODS We retrospectively analyzed MSCT data of 1,079 patients performed for procedural planning in patients referred for TAVI between January 2011 and December 2014. Of those, 29 patients were lost to follow-up and were excluded from analysis. IF were classified into location (thorax, abdomen and pelvis) and into clinical relevance (not relevant vs. relevant). RESULTS In total, 1,050 patients were analyzed and 3,194 IF were identified. Of these 2,872 IF were categorized as clinically not relevant, whereas 322 IF met radiological criteria for clinical relevance. In 25% (258/1050) of patients at least one clinical relevant IF was identified. Age (797 years vs. 807 years; p¼0.19) and EuroScore II (4% [2-6] vs. 4% [2-6]; p¼0.87) did not differ between patients with clinical relevant IF compared to those without. Prevalence of smoking, abnormal kidney function or diabetes was similar between both groups. Identification of clinical relevant IF lead to additional diagnostics in 45% (116/258) of cases and to additional therapy (medical, interventional or surgical) in 25% (65/258) of patients. TAVI was performed less frequently in patients with clinical relevant IF (76% vs. 85%, p<0.001). If TAVI was performed, mortality (20% vs. 23%; p¼0.51) and survival (582389 days vs. 611420 days; p¼0.39) did not differ between both groups. CONCLUSION To our knowledge, this is the largest study to analyze prevalence, clinical relevance and consequences of IF during TAVI work-up. IF in pre-procedural MSCT are common and clinically relevant in 25% of patients. In case of clinically relevant IF, TAVI is less frequently performed. However, these findings had no impact on mortality or survival of patients after TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-715 Abstract Withdrawn
TCT-716 A DW-MRI and MSCT-Study to assess predictors of cerebral embolism during transcatheter aortic valve implantation Ermela Yzeiraj,1 Klaudija Bijuklic,2 Timo Haselbach,3 Korff Krause,4 Julian Witt,5 Lorenz Hansen,6 Friedrich-Christian Riess,7 Joachim Schofer8 1 Prof. Mathey, Prof. Schofer Medizinisches Versorgungszentrum, Hamburg, Germany; 2tctmd.com, Hamburg, Germany; 3Albertinen Krankenhaus, Hamburg, Germany; 4Albertinen Heart Center, Hamburg Germany; 5Albertinen Krankenhaus Hamburg, Uetersen, Germany; 6 Albertinen Krankenhaus, Hamburg, Germany; 7The Heart Hospital Baylor Plano; 8Hamburg University Cardiovascular Center, Hamburg, Germany BACKGROUND Transcatheter aortic valve implantation (TAVI) is known to be associated with the risk of cerebral infarcts (CI). Cerebral embolic protection devices are under clinical evaluation but the indication for their use has not yet been defined. We aimed to identify predictive risk factors for the occurrence of CI in patients undergoing TAVI. METHODS 247 TAVI patients who underwent cerebral DW-MRI 3-5 days after the procedure were enrolled. 176 patients (71%) received SAPIEN valve (Edwards Lifesciences, California) (ES) and 71 patients (29%) a Direct Flow Medical valve (Direct Flow Medical, California) (DFM). The access was transfemoral in 97%, transaortic in 2% and transapical in 1% of cases. Cerebral DW-MRI were analysed by a blinded physician to assess the incidence, number and volume of new CI. Volumetric quantification of calcification of the aortic valve complex (AVC) including left ventricular outflow tract and aortic root (AR) were assessed from contrast-enhanced MSCT.
RESULTS DFM patients (mean age 825 yrs, EuroSCORE 2010.5%) had a higher incidence of CI respect ES patients (mean age 827 yrs, EuroSCORE 21.212.9%) (86% versus 66%, p¼0.002). Also mean lesion volume was bigger in DFM group (37979 versus 20222 mm3, p¼0.004). In the ES group patients with CI were older (p¼0.043), more often treated with a 29 mm valve (p¼0.036) and had a more calcified AVC, in particular AR (p¼0.033). Binary logistic regression analysis identified valve size (OR 2.620) and AR calcification (OR 1.002) as independent predictors of CI in ES patients. In the DFM group there were no significant differences between patients with and without CI and no independent predictor for CI was identified. CI were silent in 98% of cases. Stroke occurred in four patients, not different in the two cohorts. CONCLUSION TAVI is associated with a high rate of new CI and the majority of them are silent. Whereas the risk of CI in ES patients increases with increasing valve size and degree of aortic root calcification, no clinical, echocardiographic, MSCT or procedural factor were found to be predictor of CI in the DFM patients. These findings might help identifying patients who need a cerebral embolic protection device for TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-717 Transcatheter Aortic Valve Replacement Reduces Major Recurrent Gastrointestinal Bleed in Severe Aortic Stenosis Rafath Ullah,1 Mubeen Khan Mohammed Abdul,2 Khalil Odeh,3 Tanvir Bajwa,4 Suhail Q. Allaqaband,5 Amanda Kirby,6 Daniel P. O’Hair,7 Tonga Nfor8 1 Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; 2The Royal Brompton Hospital; 3University of Massachusetts Medical School; 4Awal Bros Hospital Pekanbaru; 5Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; 6Aurora Health Care, Milwaukee, Wisconsin, United States; 7 University Heart Center Hamburg; 8Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers BACKGROUND Severe aortic stenosis is associated with acquired Von Willebrand deficiency (vWD) manifesting with recurrent gastrointestinal bleed (GIB) if left untreated. Few small studies have shown decreased incidence of GIB after surgical aortic valve replacement (SAVR) but limited data are available with transcatheter aortic valve replacement (TAVR). We sought to investigate the effect of TAVR on GIB in patients with severe aortic stenosis. METHODS Comprehensive retrospective analysis of 654 TAVR patients at a large tertiary care center from May 2011 to April 2016. Each patient was screened for the number of major and minor GIB one year prior to valve replacement and followed for the incidence of recurrent GIB post valve replacement. RESULTS 69 of 654 patients (10.6%) undergoing TAVR had GIB before valve replacement. CoreValve (MedTronic, Minneapolis, Minn.) was used in 72% and Evolut (Medtronic) 28%. Mean age was 827.9 years and 45% were women. The mean STS score was 9.2, deemed high risk. 76.7% of the patients with GIB before valve replacement had at least one major bleeding episode. Median follow-up was 12.3 months. Of all patients with GIB before valve replacement only 4 (5.5%) had recurrent GIB post valve replacement. There was no difference in the use of antiplatelets before vs. after valve replacement (92.7% vs. 97.2%); long-term anticoagulation (37.1% vs 45.2%); or proton pump inhibitors (61% vs. 72.6 % respectively); p>0.05. Angiodysplasia was found in 14 patients (20%), 1 of whom had recurrent GIB post TAVR. CONCLUSION Among patients with severe aortic stenosis who have gastrointestinal bleeding, the risk of recurrent bleed is only 5.5% after treatment with TAVR. This reduction in GIB occurs despite no significant change in use of antiplatelets, anticoagulants or proton pump inhibitors. CATEGORIES STRUCTURAL: Valvular Disease: Aortic
TCT-718 Predictors of vascular complications in women undergoing contemporary transcatheter aortic valve replacement: A report from the WIN-TAVI registry Alaide Chieffo,1 Anna Sonia Petronio,2 Julinda Mehilli,3 Jaya Chandrasekhar,4 Samantha Sartori,5 Thierry Lefevre,6
12 Unknown, Munich, Germany; 13Alfred Hospital; Herzzentrum München, Munich, Germany
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
14
Deutsches
BACKGROUND Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic valve replacement in patients at high operative risk. Multislice computed tomography (MSCT) has emerged as the mainstay in procedural planning. Because of advanced age of patients, incidental radiological findings (IF) in MSCT are common. However, the exact incidence, clinical relevance and further consequences of IF are unclear. Further, it is unknown whether patients’ outcome is adversely affected by IF. METHODS We retrospectively analyzed MSCT data of 1,079 patients performed for procedural planning in patients referred for TAVI between January 2011 and December 2014. Of those, 29 patients were lost to follow-up and were excluded from analysis. IF were classified into location (thorax, abdomen and pelvis) and into clinical relevance (not relevant vs. relevant). RESULTS In total, 1,050 patients were analyzed and 3,194 IF were identified. Of these 2,872 IF were categorized as clinically not relevant, whereas 322 IF met radiological criteria for clinical relevance. In 25% (258/1050) of patients at least one clinical relevant IF was identified. Age (797 years vs. 807 years; p¼0.19) and EuroScore II (4% [2-6] vs. 4% [2-6]; p¼0.87) did not differ between patients with clinical relevant IF compared to those without. Prevalence of smoking, abnormal kidney function or diabetes was similar between both groups. Identification of clinical relevant IF lead to additional diagnostics in 45% (116/258) of cases and to additional therapy (medical, interventional or surgical) in 25% (65/258) of patients. TAVI was performed less frequently in patients with clinical relevant IF (76% vs. 85%, p<0.001). If TAVI was performed, mortality (20% vs. 23%; p¼0.51) and survival (582389 days vs. 611420 days; p¼0.39) did not differ between both groups. CONCLUSION To our knowledge, this is the largest study to analyze prevalence, clinical relevance and consequences of IF during TAVI work-up. IF in pre-procedural MSCT are common and clinically relevant in 25% of patients. In case of clinically relevant IF, TAVI is less frequently performed. However, these findings had no impact on mortality or survival of patients after TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-715 Abstract Withdrawn
TCT-716 A DW-MRI and MSCT-Study to assess predictors of cerebral embolism during transcatheter aortic valve implantation Ermela Yzeiraj,1 Klaudija Bijuklic,2 Timo Haselbach,3 Korff Krause,4 Julian Witt,5 Lorenz Hansen,6 Friedrich-Christian Riess,7 Joachim Schofer8 1 Prof. Mathey, Prof. Schofer Medizinisches Versorgungszentrum, Hamburg, Germany; 2tctmd.com, Hamburg, Germany; 3Albertinen Krankenhaus, Hamburg, Germany; 4Albertinen Heart Center, Hamburg Germany; 5Albertinen Krankenhaus Hamburg, Uetersen, Germany; 6 Albertinen Krankenhaus, Hamburg, Germany; 7The Heart Hospital Baylor Plano; 8Hamburg University Cardiovascular Center, Hamburg, Germany BACKGROUND Transcatheter aortic valve implantation (TAVI) is known to be associated with the risk of cerebral infarcts (CI). Cerebral embolic protection devices are under clinical evaluation but the indication for their use has not yet been defined. We aimed to identify predictive risk factors for the occurrence of CI in patients undergoing TAVI. METHODS 247 TAVI patients who underwent cerebral DW-MRI 3-5 days after the procedure were enrolled. 176 patients (71%) received SAPIEN valve (Edwards Lifesciences, California) (ES) and 71 patients (29%) a Direct Flow Medical valve (Direct Flow Medical, California) (DFM). The access was transfemoral in 97%, transaortic in 2% and transapical in 1% of cases. Cerebral DW-MRI were analysed by a blinded physician to assess the incidence, number and volume of new CI. Volumetric quantification of calcification of the aortic valve complex (AVC) including left ventricular outflow tract and aortic root (AR) were assessed from contrast-enhanced MSCT.
RESULTS DFM patients (mean age 825 yrs, EuroSCORE 2010.5%) had a higher incidence of CI respect ES patients (mean age 827 yrs, EuroSCORE 21.212.9%) (86% versus 66%, p¼0.002). Also mean lesion volume was bigger in DFM group (37979 versus 20222 mm3, p¼0.004). In the ES group patients with CI were older (p¼0.043), more often treated with a 29 mm valve (p¼0.036) and had a more calcified AVC, in particular AR (p¼0.033). Binary logistic regression analysis identified valve size (OR 2.620) and AR calcification (OR 1.002) as independent predictors of CI in ES patients. In the DFM group there were no significant differences between patients with and without CI and no independent predictor for CI was identified. CI were silent in 98% of cases. Stroke occurred in four patients, not different in the two cohorts. CONCLUSION TAVI is associated with a high rate of new CI and the majority of them are silent. Whereas the risk of CI in ES patients increases with increasing valve size and degree of aortic root calcification, no clinical, echocardiographic, MSCT or procedural factor were found to be predictor of CI in the DFM patients. These findings might help identifying patients who need a cerebral embolic protection device for TAVI. CATEGORIES STRUCTURAL: Valvular Disease: Aortic TCT-717 Transcatheter Aortic Valve Replacement Reduces Major Recurrent Gastrointestinal Bleed in Severe Aortic Stenosis Rafath Ullah,1 Mubeen Khan Mohammed Abdul,2 Khalil Odeh,3 Tanvir Bajwa,4 Suhail Q. Allaqaband,5 Amanda Kirby,6 Daniel P. O’Hair,7 Tonga Nfor8 1 Aurora St Luke’s Medical Center, Milwaukee, Wisconsin, United States; 2The Royal Brompton Hospital; 3University of Massachusetts Medical School; 4Awal Bros Hospital Pekanbaru; 5Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers; 6Aurora Health Care, Milwaukee, Wisconsin, United States; 7 University Heart Center Hamburg; 8Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers BACKGROUND Severe aortic stenosis is associated with acquired Von Willebrand deficiency (vWD) manifesting with recurrent gastrointestinal bleed (GIB) if left untreated. Few small studies have shown decreased incidence of GIB after surgical aortic valve replacement (SAVR) but limited data are available with transcatheter aortic valve replacement (TAVR). We sought to investigate the effect of TAVR on GIB in patients with severe aortic stenosis. METHODS Comprehensive retrospective analysis of 654 TAVR patients at a large tertiary care center from May 2011 to April 2016. Each patient was screened for the number of major and minor GIB one year prior to valve replacement and followed for the incidence of recurrent GIB post valve replacement. RESULTS 69 of 654 patients (10.6%) undergoing TAVR had GIB before valve replacement. CoreValve (MedTronic, Minneapolis, Minn.) was used in 72% and Evolut (Medtronic) 28%. Mean age was 827.9 years and 45% were women. The mean STS score was 9.2, deemed high risk. 76.7% of the patients with GIB before valve replacement had at least one major bleeding episode. Median follow-up was 12.3 months. Of all patients with GIB before valve replacement only 4 (5.5%) had recurrent GIB post valve replacement. There was no difference in the use of antiplatelets before vs. after valve replacement (92.7% vs. 97.2%); long-term anticoagulation (37.1% vs 45.2%); or proton pump inhibitors (61% vs. 72.6 % respectively); p>0.05. Angiodysplasia was found in 14 patients (20%), 1 of whom had recurrent GIB post TAVR. CONCLUSION Among patients with severe aortic stenosis who have gastrointestinal bleeding, the risk of recurrent bleed is only 5.5% after treatment with TAVR. This reduction in GIB occurs despite no significant change in use of antiplatelets, anticoagulants or proton pump inhibitors. CATEGORIES STRUCTURAL: Valvular Disease: Aortic
TCT-718 Predictors of vascular complications in women undergoing contemporary transcatheter aortic valve replacement: A report from the WIN-TAVI registry Alaide Chieffo,1 Anna Sonia Petronio,2 Julinda Mehilli,3 Jaya Chandrasekhar,4 Samantha Sartori,5 Thierry Lefevre,6