Bệnh viện Đa khoa Tâm Anh TP.HCM chính thức làm chủ kỹ thuật TAVI – cấy van động mạch chủ qua ống thông, trở thành Trung tâm độc lập thực hiện kỹ thuật này sau khi được 2 tập đoàn y khoa hàng đầu Hoa Kỳ công nhận. Kỹ thuật TAVI là can thiệp tim mạch cấp cao, ít xâm lấn, giúp bệnh nhân hẹp van động mạch chủ nặng tránh phẫu thuật mở tim. Thành tựu đạt được chỉ trong 4 tháng thể hiện bước tiến mạnh mẽ của y học Việt Nam.
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🫀📄 #WorldHeartDay: 'Electrocardiographic Strain and Relationship with Left Ventricular Remodelling and Clinical Outcomes in Patients with Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation' - a research article in the Karger: Cardiovascular System Collection on #ScienceOpen 🔗 https://www.scienceopen.com/document?vid=96c293ec-03c9-46ed-bf91-ce2b451d58b7
<p xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" dir="auto" id="d7341480e220"> <b> <i>Introduction:</i> </b> Left ventricular (LV) remodelling and fibrosis are known to occur in patients with aortic stenosis (AS) and are linked to post-intervention outcomes. These myocardial changes may be detected upon the routine 12-lead electrocardiogram (ECG) by the presence of a LV strain pattern (LVS-ECG). Although LVS-ECG has been related to excessive cardiovascular morbidity and mortality in multiple patient populations, there is currently a dearth of data upon its impact in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the current study was to investigate the prevalence, predictors, and prognostic value of LVS-ECG. <b> <i>Methods:</i> </b> Between 2012 and 2019, 640 consecutive patients underwent TAVI at Haukeland University Hospital, Bergen. Of these, 600 patients with severe AS were included in the TAVI-NOR study. Patients with known bundle branch block ( <i>n</i> = 85) or permanent pacing ( <i>n</i> = 25) were excluded, leaving 490 patients (mean age 81 ± 6 years, 52% females) eligible for the analyses. LVS-ECG was defined as down-sloping, convex ST-segment depression with asymmetric T-wave inversion in V5 or V6. <b> <i>Results:</i> </b> LVS-ECG was present in 25.7% patients. Higher levels of NT-proBNP (OR 1.96; 95% CI: 1.08–3.55, <i>p</i> = 0.028), left ventricular ejection fraction (LVEF) <50% (OR 3.14; 95% CI: 1.61–6.13, <i>p</i> = 0.001), increase in LV mass index per SD (32 g/m <sup>2</sup>) (OR 1.37; 95 CI: 1.06–1.76, <i>p</i> = 0.014), and the presence of LV hypertrophy on ECG (OR 3.23; 95% CI: 1.97–5.32, <i>p</i> < 0.001) were independent predictors of LVS-ECG in the multivariable-adjusted analysis. Although all-cause mortality was significantly higher in patients with LVS-ECG compared to those without (54.8% vs. 44.2%, <i>p</i> = 0.041), the presence of LVS-ECG did not predict all-cause mortality during a mean follow-up of 64 ± 24 months (HR 1.05; 95% CI: 0.79–1.39, <i>p</i> = 0.742). Patients with LVEF <50% and concomitant LVS-ECG had a worse prognosis than those with LVEF >50% and no LVS-ECG ( <i>p</i> < 0.001). <b> <i>Conclusions:</i> </b> LVS-ECG may represent a simple marker of structural and functional LV remodelling that signals a propensity to excess mortality during long-term follow-up after TAVI, as it is strongly associated with other prognosticators such as reduced LVEF and increased levels of NT-proBNP. </p>
Medscape: #TAVI bei bikuspider Aortenklappe: Höhere Mortalität als bei chirurgischer Intervention
Eine retrospektive Analyse zeigt Nachteile des kathetergestützten Klappenersatzes bei jungen Patienten mit bikuspider Aortenklappe. Experten fordern, Patienten gezielter zu selektieren.
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Educational Review: CT imaging post-#TAVI - Murphy’s first law in action—preparing to recognize the unexpected. (Costanza Lisi et al.)
Abstract Transfemoral aortic valve implantation (TAVI) has been long considered the standard of therapy for high-risk patients with severe aortic-stenosis and is now effectively employed in place of surgical aortic valve replacement also in intermediate-risk patients. The potential lasting consequences of minor complications, which might have limited impact on elderly patients, could be more noteworthy in the longer term when occurring in younger individuals. That’s why a greater focus on early diagnosis, correct management, and prevention of post-procedural complications is key to achieve satisfactory results. ECG-triggered multidetector computed tomography angiography (CTA) is the mainstay imaging modality for pre-procedural planning of TAVI and is also used for post-interventional early detection of both acute and long-term complications. CTA allows detailed morphological analysis of the valve and its movement throughout the entire cardiac cycle. Moreover, stent position, coronary artery branches, and integrity of the aortic root can be precisely evaluated. Imaging reliability implies the correct technical setting of the computed tomography scan, knowledge of valve type, normal post-interventional findings, and awareness of classic and life-threatening complications after a TAVI procedure. This educational review discusses the main post-procedural complications of TAVI with a specific imaging focus, trying to clearly describe the technical aspects of CTA Imaging in post-TAVI and its clinical applications and challenges, with a final focus on future perspectives and emerging technologies. Critical relevance statement This review undertakes an analysis of the role computed tomography angiography (CTA) plays in the assessment of post-TAVI complications. Highlighting the educational issues related to the topic, empowers radiologists to refine their clinical approach, contributing to enhanced patient care. Key Points Prompt recognition of TAVI complications, ranging from value issues to death, is crucial. Adherence to recommended scanning protocols, and the optimization of tailored protocols, is essential. CTA is central in the diagnosis of TAVI complications and functions as a gatekeeper to treatment. Graphical Abstract
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10 year follow up outcomes of TAVR vs surgical aortic valve, reassuring we do not seem to be building a young cohort heading for difficulties.
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehae043/7601592
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