OBJECTIVE: Management of patients with severe aortic stenosis (AS) may differ according to the patient sex. This study aimed to describe patterns of aortic valve replacement (AVR) for severe AS across Europe, including stratification by sex. METHODS: Procedure volume data for surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) for six years (2015-2020) were extracted from national databases for Austria, Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland and stratified by sex. Patients per million population (PPM) undergoing AVR per year were calculated using population estimates from Eurostat. RESULTS: Between 2015 and 2019, AVR procedures grew at an average annual rate of 3.9%. In 2020, the average total PPM undergoing AVR across all countries was 339, with 51% of procedures being TAVI and 49% SAVR. AVR PPM varied widely between countries, with the highest and lowest in Germany and Poland, respectively. The average total PPM was higher for men than women (423 vs. 258), but a higher proportion of women (62%) than men (44%) received TAVI. The proportion of TAVI among total AVR procedures increased with age, with an overall average of 96% of men and 98% of women aged ≥85 years receiving TAVI; however, adoption of TAVI varied by country. CONCLUSIONS: The analysis of temporal trends in the adoption of TAVI vs. SAVR across Europe showed significant variations. Despite the higher use of TAVI vs. SAVR in women, overall rates of AV intervention in women were lower compared to men.

• MeSH
• Aortic Valve surgery   MeSH
• Aortic Valve Stenosis * surgery   epidemiology   MeSH
• Heart Valve Prosthesis Implantation trends   statistics & numerical data   MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sex Factors MeSH
• Transcatheter Aortic Valve Replacement trends   statistics & numerical data   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

Background Despite the availability of guidelines for the performance of transcatheter aortic valve implantation (TAVI), current treatment pathways vary between countries and institutions, which impact on the mean duration of postprocedure hospitalization. Methods and Results This was a prospective, multicenter registry of 502 patients to validate the appropriateness of discharge timing after transfemoral TAVI, using prespecified risk criteria from FAST-TAVI (Feasibility and Safety of Early Discharge After Transfemoral [TF] Transcatheter Aortic Valve Implantation), based on hospital events within 1-year after discharge. The end point-a composite of all-cause mortality, vascular access-related complications, permanent pacemaker implantation, stroke, cardiac rehospitalization, kidney failure, and major bleeding-was reached in 27.0% of patients (95% CI, 23.3-31.2) within 1 year after intervention; 7.5% (95% CI, 5.5-10.2) had in-hospital complications before discharge and 19.6% (95% CI, 16.3-23.4) within 1 year after discharge. Overall mortality within 1 year after discharge was 7.3% and rates of cardiac rehospitalization 13.5%, permanent pacemaker implantation 4.2%, any stroke 1.8%, vascular-access-related complications 0.7%, life-threatening bleeding 0.7%, and kidney failure 0.4%. Composite events within 1 year after discharge were observed in 18.8% and 24.3% of patients with low risk of complications/early (≤3 days) discharge and high risk and discharged late (>3 days) (concordant discharge), respectively. Event rate in patients with discordant discharge was 14.3% with low risk but discharged late and increased to 50.0% in patients with high risk but discharged in ≤3 days. Conclusions The FAST-TAVI risk assessment provides a tool for appropriate, risk-based discharge that was validated with the 1-year event rate after transfemoral TAVI. Registration URL: https://www.ClinicalTrials.gov; Unique identifier: NCT02404467.

• MeSH
• Humans MeSH
• Postoperative Complications epidemiology   MeSH
• Patient Discharge * MeSH
• Prospective Studies MeSH
• Registries * MeSH
• Transcatheter Aortic Valve Replacement statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Geographicals
• Europe MeSH

Chirurgické i katetrizační intervence na stenotických či nedomykajících chlopních jsou jedinou uznávanou efektivní léčbou nemocných s hemodynamicky významnou vadou. Intervenční léčba chlopní s sebou nese rizika trombotických i krvácivých komplikací. Ačkoliv antitrombotika snižují rizika intervenční léčby, optimální léčebné schéma a délka terapie zůstávají neznámé. Tento článek přináší přehled recentních informací týkajících se této problematiky, stejně tak přehled současné evidence antitrombotické terapie po intervenční léčbě chlopenních onemocnění.

Surgical and catheter interventions on stenotic or insufficient valves are the only acknowledged effective treatment for patients with a haemodynamically significant defect. Interventional valve repair carries a risk of both thrombotic and bleeding complications. Although antithrombotic drugs reduce the risks of interventional treatment, an optimal therapeutic regimen and treatment duration remain unknown. This article presents an overview of recent information on this issue as well as a review of current evidence on antithrombotic therapy following interventional treatment for valvular heart disease.

• MeSH
• Anticoagulants therapeutic use   MeSH
• Aortic Valve surgery   pathology   MeSH
• Heart Valve Prosthesis Implantation * methods   statistics & numerical data   MeSH
• Dual Anti-Platelet Therapy methods   statistics & numerical data   MeSH
• Heparin therapeutic use   MeSH
• Platelet Aggregation Inhibitors * therapeutic use   MeSH
• Humans MeSH
• Heart Valve Diseases therapy   MeSH
• Heart Valve Prosthesis adverse effects   statistics & numerical data   MeSH
• Transcatheter Aortic Valve Replacement methods   statistics & numerical data   MeSH
• Thromboembolism prevention & control   MeSH
• Warfarin therapeutic use   MeSH
• Check Tag
• Humans MeSH

Od první transkatetrové implantace aortální chlopně (TAVI) v roce 2002 doznala tato metoda nebývalého rozmachu. Původně byla TAVI určena pouze pro inoperabilní a vysoce rizikové nemocné, v současné době je schválena i pro nemocné s nízkým rizikem. Jako každá invazivní metoda má i TAVI své komplikace, nevyjímaje infekční protézovou endokarditidu (TAVI-IE). Její incidence je udávána v rozmezí 0,2 až 3,4 %, mortalita až 67 % do dvou let od potvrzení diagnózy. Cílem tohoto článku je podat přehled současných poznatků o této závažné komplikaci.

Since the first transcatheter aortic valve implantation (TAVI) this method has spread out widely. Originally, this method was indicated for inoperable and high-risk patients; nowadays it has FDA approval even for low-risk patients. As any invasive procedure, TAVI is also associated with complications, including prosthetic valve endocarditis (TAVI-IE). The incidence of TAVI-IE is reported to be 0.2-3.4 % and its mortality up to 67 % at two years after confirmation of the diagnosis. The aim of this article is to review current knowledge on this serious complication.

• Keywords
• TAVI-IE,
• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Endocarditis, Bacterial diagnosis   etiology   prevention & control   MeSH
• Echocardiography methods   MeSH
• Endocarditis * etiology   physiopathology   prevention & control   MeSH
• Humans MeSH
• Risk Factors MeSH
• Heart Valve Prosthesis adverse effects   MeSH
• Streptococcal Infections diagnosis   etiology   drug therapy   MeSH
• Transcatheter Aortic Valve Replacement * methods   adverse effects   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

• MeSH
• Patient Safety MeSH
• Congresses as Topic MeSH
• Humans MeSH
• Equipment Failure MeSH
• Transcatheter Aortic Valve Replacement * economics   methods   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Newspaper Article MeSH
• News MeSH

• MeSH
• Heart Valve Prosthesis Implantation methods   MeSH
• Humans MeSH
• Transcatheter Aortic Valve Replacement * methods   statistics & numerical data   trends   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Newspaper Article MeSH

• MeSH
• Risk Assessment MeSH
• Humans MeSH
• Transcatheter Aortic Valve Replacement * methods   statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Newspaper Article MeSH

První transkatétrová implantace aortální chlopně (TAVI) v České republice byla provedena v roce 2008 a od té doby je více než 90 % všech výkonů TAVI provedených v České republice zahrnuto do online vedeného Českého registru TAVI. Patnáct set třicet dva výkonů TAVI provedených od roku 2008 do konce června 2016 u pacientů se symptomatickou a významnou aortální stenózou a vysokým rizikem (medián logistického EuroSCORE 18,2 a věku 80 let) bylo spojeno s příznivými výsledky, co se týče bezpečnosti (nemocniční mortalita 3,9 %, významná paravalvulární aortální regurgitace po TAVI 1,0 %) a účinnosti (index plochy aortálního ústí před TAVI versus po TAVI byl 0,4 cm2 /m2 versus 1,0 cm2 /m2 ). U většiny pacientů (83,7 %) byla indikována TAVI kvůli vysokému operačnímu riziku, které posoudil kardiotým, a 71,9 % pacientů bylo propuštěno do domácího ošetřování.

The fi rst TAVI in the Czech Republic was performed in 2008 and since then, more than 90% of TAVI procedures have been involved in the online all comers Czech TAVI Registry. From 2008 till June 2016 1 532 TAVI procedures in a high risk population with symptomatic severe aortic stenosis (logistic EuroSCORE 18.2, median age 80 years) were relatively safe (in-hospital mortality 3.9%, severe paravalvular leakage after TAVI 1.0%) and highly effective (index of aortic valve area before versus after TAVI was 0.4 cm2 /m2 versus 1.0 cm2 /m2 , respectively). Majority of patients (83.7%) underwent TAVI because of their high risk for surgery assessed by the Heart team discussion and 71.9% of them were discharged home.

• MeSH
• Aortic Valve Stenosis surgery   MeSH
• Humans MeSH
• Registries MeSH
• Transcatheter Aortic Valve Replacement * statistics & numerical data   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH