Objectives. To compare the incidence of mortality and complications between nonagenarians and younger patients undergoing transcatheter aortic valve replacement (TAVR). Background. TAVR has become an alternative treatment for nonagenarian patients with severe aortic stenosis. Previous studies have reported conflicting results regarding the clinical outcomes between nonagenarians and younger patients who underwent TAVR. Methods. We searched PubMed, EMBASE, and Cochrane Library databases with predefined criteria from the inception dates to July 8, 2018. The primary clinical endpoint was 30-day and 1-year all-cause mortalities. Secondary outcomes were considered the rates of stroke, myocardial infarction, any bleeding, any acute kidney injury, any vascular complications, new pacemaker implantation, and conversion to surgical aortic valve replacement. Results. A total of 5 eligible studies with 25,371 patients were included in this meta-analysis. Compared with younger patients who underwent TAVR, nonagenarians had a significantly higher mean Society of Thoracic Surgeons score (STS score) (MD, 2.80; 95&#x25;CI: 2.58, 3.30; P&#x3c;0.00001) and logistic European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE) (MD, 2.72; 95&#x25;CI: 1.01, 4.43; P=0.002). Nonagenarians were associated with significantly higher 30-day mortality (6.2&#x25; vs. 3.7&#x25;; OR, 1.73; 95&#x25;CI: 1.49, 2.00) and 1-year mortality (15.5&#x25; vs. 11.8&#x25;; OR, 1.39; 95&#x25;CI: 1.26, 1.53), without significant statistical heterogeneity. Nonagenarians were associated with significantly increased rates of major or life-threatening bleeding, vascular complications and stroke of 20&#x25;, 35&#x25;, and 32&#x25;, respectively. There were no significant differences in the rate of myocardial infarction, stage 2 or 3 acute kidney injury, new pacemaker implantation, or conversion to surgical aortic valve replacement. Conclusions. Nonagenarians showed worse clinical outcomes than younger patients after TAVR, while the incidence of mortality was acceptable. TAVR remains an option for nonagenarian patients with severe aortic stenosis and should be comprehensively evaluated by the heart valve team.

Yan Liu

Yu Du

Mingjie Fu

Yue Ma

Deguang Wang

Jinglin Zhang

Wei Liu

Yingxin Zhao

Yujie Zhou

Clinical Outcomes of Transcatheter Aortic Valve Replacement in Nonagenarians: A Systematic Review and Meta-Analysis

Objective. To evaluate the safety and efficacy of interventional care in pediatric hemoptysis for anomalous bronchial arteries (BAs) and to identify the potential factors resulting in hemoptysis recurrence. Methods. 20 children complained of hemoptysis were diagnosed with anomalous BAs. All patients received transcatheter plug occlusion in Department of Cardiology, Children&#x2019;s Hospital of Chongqing Medical University. The safety and efficacy were evaluated according to clinical symptoms and images monitoring of enrolled subjects grouped as recurrence group and nonrecurrence group. The potential factors causing hemoptysis recurrence were reviewed and summarized. Results. No deaths were recorded in a follow-up. Otherwise, hemoptysis recurrence was found in 8 subjects for 14 times, accounting for about 40&#x25;. Compared with nonrecurrence group, it indicated a statistical significance in hemoglobin levels (P=0.049), mycoplasma pneumonia particle assays (MP-PA) titers (P=0.030), and number of anomalous BAs (P=0.020). Meanwhile, 50&#x25; recurrent scenarios were associated with a respiratory infection by microbiological assessment before transcatheter plug occlusion. The repeat occlusion was applied for unclosed BAs leading to visual recurrent hemoptysis, the average interval time of which was 5.4 &#xb1; 3.6 mon. Conclusion. The data from this retrospective study have shown that transcatheter plug occlusion is a relatively safe procedure with a low mortality. The number of abnormal BAs has been identified as a highly significant predictor of recurrence, and the role of MP and other potential factors should be verified in a multicenter, larger sample size, and randomized controlled trial.

Hong-Yu Kuang

Qiang Li

Ping Xiang

Chuan Feng

Qi-Jian Yi

Tie-Wei Lu

Potential Factors Affected Safety and Efficacy of Transcatheter Plug Closure for Pediatric Hemoptysis with Anomalous Bronchial Arteries

Objectives. The aim of this study was to investigate the outcomes of left atrial appendage occlusion (LAAO) in high bleeding risk patients suffering atrial fibrillation (AF) and to analyze the different antithrombotic therapies following the intervention. Background. Methods. This monocentric study included 68 patients with nonvalvular AF with an absolute contraindication to OAT or at high bleeding risk. Follow-up was done with a clinical visit at 3-6-12 months. Results. Successful LAAO was achieved in 67/68 patients. At discharge, 32/68 patients were on dual antiplatelet therapy (APT), 34/68 were without any antithrombotic therapy or with a single antiplatelet drug, and 2/68 were on anticoagulant therapy. At three-month follow-up visit, 73.6&#x25; of the patients did not receive dual APT, of whom 14.7&#x25; had no thrombotic therapy and 58.9&#x25; were on single antiplatelet therapy. During a follow-up of 1.4 &#xb1; 0.9 years, 3/62 patients had late adverse effects (2 device-related thrombus without clinical consequences and 1 extracranial bleeding). The device-related thrombosis was not related to the antithrombotic therapy. Conclusions. LAAO is feasible and safe and prevents stroke in patients with AF with contraindication to oral anticoagulant therapy. After LAAO, single antiplatelet therapy seems to be a safe alternative to dual antiplatelet therapy, especially in patients at high bleeding risk. No benefit has been observed with dual APT.

Pierluigi Merella

Giovanni Lorenzoni

Alessandro P. Delitala

Filomena Sechi

Federica Decandia

Graziana Viola

Paola Berne

Gianluca Deiana

Patrizio Mazzone

Gavino Casu

Left Atrial Appendage Occlusion in High Bleeding Risk Patients

Objectives. We analyzed the efficacy of drug coated balloons (DCB) as a stand-alone-therapy in de novo lesions of large coronary arteries. DCBs seem to be an attractive alternative for the stent-free interventional treatment of de novo coronary artery disease (CAD). However, data regarding a DCB-only approach in de novo CAD are currently limited to vessels of small caliber. Methods. By means of propensity score (PS) matching 234 individuals with de novo CAD were identified with similar demographic characteristics. This patient population was stratified in a 1:1 fashion according to a reference vessel diameter cut-off of 2.75 mm in small and large vessel disease. The primary endpoint was the rate of clinically driven target lesion revascularization (TLR) at 9 months. Results. Patients with small vessel disease had an average reference diameter of 2.45 &#xb1; 0.23 mm, while the large vessel group averaged 3.16 &#xb1; 0.27 mm. Regarding 9-month major adverse cardiac event (MACE), 5.7&#x25; of the patients with small and 6.1&#x25; of the patients with large vessels had MACE (p=0.903). Analysis of the individual MACE components revealed a TLR rate of 3.8&#x25; in small and 1.0&#x25; in large vessels (p=0.200). Of note, no thrombotic events in the DCB treated coronary segments occurred in either group during the 9-month follow-up. Conclusions. Our data demonstrate for the first time that DCB-only PCI of de novo lesions in large coronary arteries (&#x3e;2.75 mm) is safe and as effective. Interventional treatment for CAD without permanent or temporary scaffolding, demonstrated a similar efficacy for large and small vessels.

Mark Rosenberg

Matthias Waliszewski

Florian Krackhardt

Kenneth Chin

Wan Azman Wan Ahmad

Giuseppe Caramanno

Diego Milazzo

Amin Ariff Nuruddin

Houng Bang Liew

Oteh Maskon

Angela Bento

Jean-Christophe Macia

Norbert Frey

Drug Coated Balloon-Only Strategy in De Novo Lesions of Large Coronary Vessels

Objective. To assess 1-year mortality after transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (AS). Background. Clinical trials have proven the beneficial effect of TAVR on mortality in patients with tricuspid AS. Individuals with bicuspid AS were excluded from these trials. Methods. A meta-analysis using literature search from the Cochrane, PubMed, ClinicalTrials, SCOPUS, and EMBASE databases was conducted to determine the effect of TAVR on 1-year mortality in patients with bicuspid AS. Short-term outcomes that could potentially impact one-year mortality were analyzed. Results. After evaluating 380 potential articles, 5 observational studies were selected. A total of 3890 patients treated with TAVR were included: 721 had bicuspid and 3,169 had tricuspid AS. No statistically significant difference between the baseline characteristics of the two groups of patients was seen outside of mean aortic gradient. Our primary endpoint of one-year all-cause mortality revealed 85 deaths in 719 patients (11.82&#x25;) with bicuspid AS compared to 467 deaths in 3100 patients (15.06&#x25;) with tricuspid AS, with no difference between both groups [relative risk (RR) 1.03; 95&#x25; CI 0.70-1.51]. Patients with bicuspid AS were associated with a decrease in device success (RR 0.62; 95&#x25; CI 0.45-0.84) and an increase in moderate-to-severe prosthetic valve regurgitation (RR 1.55; 95&#x25; CI 1.07-2.22) after TAVR compared to patients with tricuspid AS. The effect of meta-regression coefficients on one-year all-cause mortality was not statistically significant for any patient baseline characteristics. Conclusion. When comparing TAVR procedure in tricuspid AS versus bicuspid AS, there was no difference noted in one-year all-cause mortality.

Raymundo A. Quintana

Dominique J. Monlezun

Adrian DaSilva-DeAbreu

Uday G. Sandhu

Derick Okwan-Duodu

Jonanlis Ram&#xed;rez

Ali E. Denktas

Hani Jneid

David Paniagua

One-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement for Stenotic Bicuspid versus Tricuspid Aortic Valves: A Meta-Analysis and Meta-Regression

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Journal of Interventional Cardiology publishes articles focusing on interventional procedures and techniques in the diagnosis, investigation, and management of patients with cardiovascular disease and its associated complications.

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Chief Editor, Dr Patrizia Presbitero, is based at IRCCS Humanitas, Italy. Her main research interests include congenital heart disease and cardiocascular diseases in women.

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Journal of Interventional Cardiology - Table of contents 2019

Journal of Interventional Cardiology | Hindawi

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Journal of Interventional Cardiology publishes articles focusing on interventional procedures and techniques in the diagnosis, investigation, and management of patients with cardiovascular disease and its associated complications.

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