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1. Perioperative bleeding requiring blood transfusions is associated with increased risk of stroke after transcatheter and surgical aortic valve replacement

Author

Tauriainen, T. (Tuomas), Juvonen, T. (Tatu), Anttila, V. (Vesa), Maaranen, P. (Pasi), Niemelä, M. (Matti), Eskola, M. (Markku), Ahvenvaara, T. (Tuomas), Husso, A. (Annastiina), Virtanen, M. P. (Marko P.O.), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jalava, M. (Maina), Laine, M. (Mika), Valtola, A. (Antti), Raivio, P. (Peter), Vento, A. (Antti), Airaksinen, J. (Juhani), Mäkikallio, T. (Timo), Biancari, F. (Fausto), Tauriainen, T. (Tuomas), Juvonen, T. (Tatu), Anttila, V. (Vesa), Maaranen, P. (Pasi), Niemelä, M. (Matti), Eskola, M. (Markku), Ahvenvaara, T. (Tuomas), Husso, A. (Annastiina), Virtanen, M. P. (Marko P.O.), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jalava, M. (Maina), Laine, M. (Mika), Valtola, A. (Antti), Raivio, P. (Peter), Vento, A. (Antti), Airaksinen, J. (Juhani), Mäkikallio, T. (Timo), and Biancari, F. (Fausto)

Abstract

Objectives: The authors aimed to investigate the impact of severe bleeding and use of red blood cell (RBC) transfusion on the development of postoperative stroke after surgical (SAVR) and transcatheter aortic valve replacement (TAVR), taken from the FinnValve registry. Design: Nationwide, retrospective observational study. Setting: Five Finnish university hospitals participated in the registry. Participants: A total of 6,463 patients who underwent SAVR (n = 4,333) or TAVR (n = 2,130). Interventions: Patients who underwent TAVR or SAVR with a bioprosthesis with or without coronary revascularization. Measurements and Main Results: The incidence of postoperative stroke after SAVR was 3.8%. In multivariate analysis, the number of transfused RBC units (odds ratio [OR], 1.098; 95% confidence interval [CI], 1.064–1.133) was one of the independent predictors of postoperative stroke. The incidence of stroke increased, along with the severity of perioperative bleeding, according to the European Coronary Artery Bypass Grafting (E-CABG) bleeding grades were as follows: grade 0, 2.2% (reference group); grade 1, 3.4% (adjusted OR, 1.841; 95% CI, 1.105–3.066); grade 2, 5.5% (adjusted OR, 3.282; 95% CI, 1.948–5.529); and grade 3, 14.8% (adjusted OR, 7.103; 95% CI, 3.612–13.966). The incidence of postoperative stroke after TAVR was 2.5%. The number of transfused RBC units was an independent predictor of stroke after TAVR (adjusted OR, 1.155; 95% CI, 1.058–1.261). The incidence of postoperative stroke increased, along with the severity of perioperative bleeding, as stratified by the E-CABG bleeding grades: E-CABG grade 0, 1.7%; grade 1, 5.3% (adjusted OR, 1.270; 95% CI, 0.532–3.035); grade 2, 10.0% (adjusted OR, 2.898; 95% CI, 1.101–7.627); and grade 3, 30.0% (adjusted OR, 10.706; 95% CI, 2.389–47.987). Conclusions: Perioperative bleeding requiring RBC transfusion and/or reoperation for intrathoracic bleeding is associated with an increased risk of postoperative stroke after

Published
2022

2. Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction

Author

Jalava, M. P. (Maina P.), Savontaus, M. (Mikko), Ahvenvaara, T. (Tuomas), Laakso, T. (Teemu), Virtanen, M. (Marko), Niemelä, M. (Matti), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Husso, A. (Annastiina), Kinnunen, E. (Eve), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Rosato, S. (Stefano), D’Errigo, P. (Paola), Laine, M. (Mika), Mäkikallio, T. (Timo), Raivio, P. (Peter), Eskola, M. (Markku), Valtola, A. (Antti), Juvonen, T. (Tatu), Biancari, F. (Fausto), Airaksinen, J. (Juhani), Anttila, V. (Vesa), Jalava, M. P. (Maina P.), Savontaus, M. (Mikko), Ahvenvaara, T. (Tuomas), Laakso, T. (Teemu), Virtanen, M. (Marko), Niemelä, M. (Matti), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Husso, A. (Annastiina), Kinnunen, E. (Eve), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Rosato, S. (Stefano), D’Errigo, P. (Paola), Laine, M. (Mika), Mäkikallio, T. (Timo), Raivio, P. (Peter), Eskola, M. (Markku), Valtola, A. (Antti), Juvonen, T. (Tatu), Biancari, F. (Fausto), Airaksinen, J. (Juhani), and Anttila, V. (Vesa)

Abstract

Background: Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis. Methods: The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction. Results: Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067–1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929–1.080, p = 0.964), respectively. Conclusions: Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration: The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.

Published
2022

3. Transcatheter and surgical aortic valve replacement in patients with bicuspid aortic valve

Author

Husso, A. (Annastiina), Airaksinen, J. (Juhani), Juvonen, T. (Tatu), Laine, M. (Mika), Dahlbacka, S. (Sebastian), Virtanen, M. (Marko), Niemelä, M. (Matti), Mäkikallio, T. (Timo), Savontaus, M. (Mikko), Eskola, M. (Markku), Raivio, P. (Peter), Valtola, A. (Antti), Biancari, F. (Fausto), Husso, A. (Annastiina), Airaksinen, J. (Juhani), Juvonen, T. (Tatu), Laine, M. (Mika), Dahlbacka, S. (Sebastian), Virtanen, M. (Marko), Niemelä, M. (Matti), Mäkikallio, T. (Timo), Savontaus, M. (Mikko), Eskola, M. (Markku), Raivio, P. (Peter), Valtola, A. (Antti), and Biancari, F. (Fausto)

Abstract

Objectives: To compare the outcomes after surgical (SAVR) and transcatheter aortic valve replacement (TAVR) for severe stenosis of bicuspid aortic valve (BAV). Methods: We evaluated the early and mid-term outcome of patients with stenotic BAV who underwent SAVR or TAVR for aortic stenosis from the nationwide FinnValve registry. Results: The FinnValve registry included 6463 AS patients and 1023 (15.8%) of them had BAV. SAVR was performed in 920 patients and TAVR in 103 patients with BAV. In the overall series, device success after TAVR was comparable to SAVR (94.2% vs. 97.1%, p = 0.115). TAVR was associated with increased rate of mild-to-severe paravalvular regurgitation (PVR) (19.4% vs. 7.9%, p < 0.0001) and of moderate-to-severe PVR (2.9% vs. 0.7%, p = 0.053). When newer-generation TAVR devices were evaluated, mild-to-severe PVR (11.9% vs. 7.9%, p = 0.223) and moderate-to-severe PVR (0% vs. 0.7%, p = 1.000) were comparable to SAVR. Type 1 N-L and type 2 L-R/R-N were the BAV morphologies with higher incidence of mild-to-severe PVR (37.5% and 100%, adjusted for new-generation prostheses p = 0.025) compared to other types of BAVs. Among 75 propensity score-matched cohorts, 30-day mortality was 1.3% after TAVR and 5.3% after SAVR (p = 0.375), and 2-year mortality was 9.7% after TAVR and 18.7% after SAVR (p = 0.268). Conclusions: In patients with stenotic BAV, TAVR seems to achieve early and mid-term results comparable to SAVR. Type 1 N-L and type 2 L-R/R-N BAV morphologies had higher incidence of PVR. Larger studies evaluating different phenotypes of BAV are needed to confirm these findings. Clinical trial registration: ClinicalTrials.gov Identifier: NCT03385915.

Published
2021

4. Terveydenhuollon kansalliset laaturekisteripilotit loppusuoralla

Author

Keinänen, M. (Mika), Brummer-Korvenkontio, H. (Henrikki), Eskola, M. (Markku), Ettala, O. (Otto), Hartikainen, J. (Juha), Hovi, P. (Petteri), Isosomppi, S. (Sanna), Kivelä, P. (Pia), Kärki, J. (Johanna), Kärkkäinen, J. (Jukka), Laatikainen, T. (Tiina), Liukko, E. (Emmi), Niemi, A. (Anu), Mattila, E. (Elina), Meriläinen, M. (Merja), Mustonen, P. (Pirjo), Pekkanen, L. (Liisa), Puolakka, K. (Kari), Relas, H. (Heikki), Sainio, S. (Salla), Salo, H. (Henri), Salonen, J. (Jonna), Sokka-Isler, T. (Tuulikki), Suvisaari, J. (Jaana), Tahkola, A. (Aapo), Tiirinki, H. (Hanna), Vähäsalo, P. (Paula), Malmivaara, A. (Antti), Keinänen, M. (Mika), Brummer-Korvenkontio, H. (Henrikki), Eskola, M. (Markku), Ettala, O. (Otto), Hartikainen, J. (Juha), Hovi, P. (Petteri), Isosomppi, S. (Sanna), Kivelä, P. (Pia), Kärki, J. (Johanna), Kärkkäinen, J. (Jukka), Laatikainen, T. (Tiina), Liukko, E. (Emmi), Niemi, A. (Anu), Mattila, E. (Elina), Meriläinen, M. (Merja), Mustonen, P. (Pirjo), Pekkanen, L. (Liisa), Puolakka, K. (Kari), Relas, H. (Heikki), Sainio, S. (Salla), Salo, H. (Henri), Salonen, J. (Jonna), Sokka-Isler, T. (Tuulikki), Suvisaari, J. (Jaana), Tahkola, A. (Aapo), Tiirinki, H. (Hanna), Vähäsalo, P. (Paula), and Malmivaara, A. (Antti)

Published
2020

5. Comparison of survival of transfemoral transcatheter aortic valve implantation versus surgical aortic valve replacement for aortic stenosis in low-risk patients without coronary artery disease

Author

Virtanen, M. P. (Marko P.O.), Airaksinen, J. (Juhani), Niemelä, M. (Matti), Laakso, T. (Teemu), Husso, A. (Annastiina), Jalava, M. P. (Maina P.), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Rosato, S. (Stefano), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), Eskola, M. (Markku), Biancari, F. (Fausto), Virtanen, M. P. (Marko P.O.), Airaksinen, J. (Juhani), Niemelä, M. (Matti), Laakso, T. (Teemu), Husso, A. (Annastiina), Jalava, M. P. (Maina P.), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Rosato, S. (Stefano), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), Eskola, M. (Markku), and Biancari, F. (Fausto)

Abstract

Increasing data support transcatheter aortic valve implantation (TAVI) as a valid option over surgical aortic valve replacement (SAVR) in the treatment for severe aortic stenosis (AS) also in patients with low operative risk. However, limited data exist on the outcome of TAVI and SAVR in low-risk patients without coronary artery disease (CAD). The FinnValve registry included data on 6463 patients who underwent TAVI or SAVR with bioprosthesis between 2008 and 2017. Herein, we evaluated the outcome of low operative risk as defined by STS-PROM score <3% and absence of CAD, previous stroke and other relevant co-morbidities. Only patients who underwent TAVI with third-generation prostheses and SAVR with Perimount Magna Ease or Trifecta prostheses were included in this analysis. The primary endpoints were 30-day and 3-year all-cause mortality. Overall, 1,006 patients (175 TAVI patients and 831 SAVR patients) met the inclusion criteria of this analysis. Propensity score matching resulted in 140 pairs with similar baseline characteristics. Among these matched pairs, 30-day mortality was 2.1% in both TAVI and SAVR cohorts (p = 1.00) and 3-year mortality was 17.0% after TAVI and 14.6% after SAVR (p = 0.805). Lower rates of bleeding and atrial fibrillation, and shorter hospital stay were observed after TAVI. The need of new permanent pacemaker implantation and the incidence of early stroke did not differ between groups. In conclusion, TAVI using third-generation prostheses achieved similar early and mid-term survival compared with SAVR in low-risk patients without CAD.

Published
2020

6. Subtype of atrial fibrillation and the outcome of transcatheter aortic valve replacement:the FinnValve study

Author

Jaakkola, J. (Jussi), Jaakkola, S. (Samuli), Airaksinen, K. E. (K. E. Juhani), Husso, A. (Annastiina), Juvonen, T. (Tatu), Laine, M. (Mika), Virtanen, M. (Marko), Maaranen, P. (Pasi), Niemelä, M. (Matti), Mäkikallio, T. (Timo), Savontaus, M. (Mikko), Tauriainen, T. (Tuomas), Valtola, A. (Antti), Vento, A. (Antti), Eskola, M. (Markku), Raivio, P. (Peter), Biancari, F. (Fausto), Jaakkola, J. (Jussi), Jaakkola, S. (Samuli), Airaksinen, K. E. (K. E. Juhani), Husso, A. (Annastiina), Juvonen, T. (Tatu), Laine, M. (Mika), Virtanen, M. (Marko), Maaranen, P. (Pasi), Niemelä, M. (Matti), Mäkikallio, T. (Timo), Savontaus, M. (Mikko), Tauriainen, T. (Tuomas), Valtola, A. (Antti), Vento, A. (Antti), Eskola, M. (Markku), Raivio, P. (Peter), and Biancari, F. (Fausto)

Abstract

Whether the subtype of atrial fibrillation affects outcomes after transcatheter aortic valve replacement for aortic stenosis is unclear. The nationwide FinnValve registry included 2130 patients who underwent primary after transcatheter aortic valve replacement for aortic stenosis during 2008–2017. Altogether, 281 (13.2%) patients had pre-existing paroxysmal atrial fibrillation, 651 (30.6%) had pre-existing non-paroxysmal atrial fibrillation and 160 (7.5%) were diagnosed with new-onset atrial fibrillation during the index hospitalization. The median follow-up was 2.4 (interquartile range: 1.6–3.8) years. Paroxysmal atrial fibrillation did not affect 30-day or overall mortality (p-values >0.05). Non-paroxysmal atrial fibrillation demonstrated an increased risk of overall mortality (hazard ratio: 1.61, 95% confidence interval: 1.35–1.92; p<0.001), but not 30-day mortality (p = 0.084). New-onset atrial fibrillation demonstrated significantly increased 30-day mortality (hazard ratio: 2.76, 95% confidence interval: 1.25–6.09; p = 0.010) and overall mortality (hazard ratio: 1.68, 95% confidence interval: 1.29–2.19; p<0.001). The incidence of early or late stroke did not differ between atrial fibrillation subtypes (p-values >0.05). In conclusion, non-paroxysmal atrial fibrillation and new-onset atrial fibrillation are associated with increased mortality after transcatheter aortic valve replacement for aortic stenosis, whereas paroxysmal atrial fibrillation has no effect on mortality. These findings suggest that non-paroxysmal atrial fibrillation rather than paroxysmal atrial fibrillation may be associated with structural cardiac damage which is of prognostic significance in patients with aortic stenosis undergoing transcatheter aortic valve replacement.

Published
2020

7. Mid-term outcomes of Sapien 3 versus Perimount Magna Ease for treatment of severe aortic stenosis

Author

Virtanen, M. P. (Marko P. O.), Eskola, M. (Markku), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Niemelä, M. (Matti), Laakso, T. (Teemu), Husso, A. (Annastiina), Jalava, M. P. (Maina P.), Tauriainen, T. (Tuomas), Ahvenvaara, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), Rosato, S. (Stefano), D’Errigo, P. (Paola), Vento, A. (Antti), Airaksinen, J. (Juhani), Biancari, F. (Fausto), Virtanen, M. P. (Marko P. O.), Eskola, M. (Markku), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Niemelä, M. (Matti), Laakso, T. (Teemu), Husso, A. (Annastiina), Jalava, M. P. (Maina P.), Tauriainen, T. (Tuomas), Ahvenvaara, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), Rosato, S. (Stefano), D’Errigo, P. (Paola), Vento, A. (Antti), Airaksinen, J. (Juhani), and Biancari, F. (Fausto)

Abstract

Background: There is limited information on the longer-term outcome after transcatheter aortic valve replacement (TAVR) with new-generation prostheses compared to surgical aortic valve replacement (SAVR). The aim of this study was to compare the mid-term outcomes after TAVR with Sapien 3 and SAVR with Perimount Magna Ease bioprostheses for severe aortic stenosis. Methods: In a retrospective study, we included patients who underwent transfemoral TAVR with Sapien 3 or SAVR with Perimount Magna Ease bioprosthesis between January 2008 and October 2017 from the nationwide FinnValve registry. Propensity score matching was performed to adjust for differences in the baseline characteristics. The Kaplan-Meir method was used to estimate late mortality. Results: A total of 2000 patients were included (689 in the TAVR cohort and 1311 in the SAVR cohort). Propensity score matching resulted in 308 pairs (STS score, TAVR 3.5 ± 2.2% vs. SAVR 3.5 ± 2.8%, p = 0.918). In-hospital mortality was 3.6% after SAVR and 1.3% after TAVR (p = 0.092). Stroke, acute kidney injury, bleeding and atrial fibrillation were significantly more frequent after SAVR, but higher rate of vascular complications was observed after TAVR. The cumulative incidence of permanent pacemaker implantation at 4 years was 13.9% in the TAVR group and 6.9% in the SAVR group (p = 0.0004). At 4-years, all-cause mortality was 20.6% for SAVR and 25.9% for TAVR (p = 0.910). Four-year rates of coronary revascularization, prosthetic valve endocarditis and repeat aortic valve intervention were similar between matched cohorts. Conclusions: The Sapien 3 bioprosthesis achieves comparable midterm outcomes to a surgical bioprosthesis with proven durability such as the Perimount Magna Ease. However, the Sapien 3 bioprosthesis was associated with better early outcome.

Published
2020

8. Comparison of outcomes after transcatheter aortic valve replacement vs surgical aortic valve replacement among patients with aortic stenosis at low operative risk

Author

Virtanen, M. P. (Marko P. O.), Eskola, M. (Markku), Jalava, M. P. (Maina P.), Husso, A. (Annastiina), Laakso, T. (Teemu), Niemelä, M. (Matti), Ahvenvaara, T. (Tuomas), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Vasankari, T. (Tuija), Airaksinen, J. (Juhani), Anttila, V. (Vesa), Rosato, S. (Stefano), D’Errigo, P. (Paola), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), Biancari, F. (Fausto), Virtanen, M. P. (Marko P. O.), Eskola, M. (Markku), Jalava, M. P. (Maina P.), Husso, A. (Annastiina), Laakso, T. (Teemu), Niemelä, M. (Matti), Ahvenvaara, T. (Tuomas), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Vasankari, T. (Tuija), Airaksinen, J. (Juhani), Anttila, V. (Vesa), Rosato, S. (Stefano), D’Errigo, P. (Paola), Savontaus, M. (Mikko), Juvonen, T. (Tatu), Laine, M. (Mika), Mäkikallio, T. (Timo), Valtola, A. (Antti), Raivio, P. (Peter), and Biancari, F. (Fausto)

Abstract

Importance: Transcatheter aortic valve replacement (TAVR) has been shown to be a valid alternative to surgical aortic valve replacement (SAVR) in patients at high operative risk with severe aortic stenosis (AS). However, the evidence of the benefits and harms of TAVR in patients at low operative risk is still scarce. Objective: To compare the short-term and midterm outcomes after TAVR and SAVR in low-risk patients with AS. Design, Setting, and Participants: This retrospective comparative effectiveness cohort study used data from the Nationwide Finnish Registry of Transcatheter and Surgical Aortic Valve Replacement for Aortic Valve Stenosis of patients at low operative risk who underwent TAVR or SAVR with a bioprosthesis for severe AS from January 1, 2008, to November 30, 2017. Low operative risk was defined as a Society of Thoracic Surgeons Predicted Risk of Mortality score less than 3% without other comorbidities of clinical relevance. One-to-one propensity score matching was performed to adjust for baseline covariates between the TAVR and SAVR cohorts. Exposures: Primary TAVR or SAVR with a bioprosthesis for AS with or without associated coronary revascularization. Main Outcomes and Measures: The primary outcomes were 30-day and 3-year survival. Results: Overall, 2841 patients (mean [SD] age, 74.0 [6.2] years; 1560 [54.9%] men) fulfilled the inclusion criteria and were included in the analysis; TAVR was performed in 325 patients and SAVR in 2516 patients. Propensity score matching produced 304 pairs with similar baseline characteristics. Third-generation devices were used in 263 patients (86.5%) who underwent TAVR. Among these matched pairs, 30-day mortality was 1.3% after TAVR and 3.6% after SAVR (P = .12). Three-year survival was similar in the study cohorts (TAVR, 85.7%; SAVR, 87.7%; P = .45). Interaction tests found no differences in terms of 3-year survival between the study cohorts in patients younger than vs older than 80 years or in patients who r

Published
2019

9. Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Author

Mäkikallio, T. (Timo), Jalava, M. P. (Maina P.), Husso, A. (Annastiina), Virtanen, M. (Marko), Laakso, T. (Teemu), Ahvenvaara, T. (Tuomas), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Airaksinen, J. (Juhani), Anttila, V. (Vesa), Savontaus, M. (Mikko), Laine, M. (Mika), Juvonen, T. (Tatu), Valtola, A. (Antti), Raivio, P. (Peter), Eskola, M. (Markku), Niemelä, M. (Matti), Biancari, F. (Fausto), Mäkikallio, T. (Timo), Jalava, M. P. (Maina P.), Husso, A. (Annastiina), Virtanen, M. (Marko), Laakso, T. (Teemu), Ahvenvaara, T. (Tuomas), Tauriainen, T. (Tuomas), Maaranen, P. (Pasi), Kinnunen, E.-M. (Eeva-Maija), Dahlbacka, S. (Sebastian), Jaakkola, J. (Jussi), Airaksinen, J. (Juhani), Anttila, V. (Vesa), Savontaus, M. (Mikko), Laine, M. (Mika), Juvonen, T. (Tatu), Valtola, A. (Antti), Raivio, P. (Peter), Eskola, M. (Markku), Niemelä, M. (Matti), and Biancari, F. (Fausto)

Abstract

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = 0.011) and from 4.1% to 1.8% for SAVR (p = 0.048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < 0.001) and from 87.2% to 91.6% for SAVR (p = 0.006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < 0.001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < 0.001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR.

Published
2019

10. Permanent work disability in patients ≤50 years old after percutaneous coronary intervention and coronary artery bypass grafting (the CRAGS study)

Author

Lautamäki, A. (Anna), Gunn, J. M. (Jarmo M.), Airaksinen, K. E. (Kari Eino Juhani), Biancari, F. (Fausto), Kajander, O. A. (Olli A.), Anttila, V. (Vesa), Heikkinen, J. (Jouni), Eskola, M. (Markku), Ilveskoski, E. (Erkki), Mennander, A. (Ari), Korpilahti, K. (Kari), Wistbacka, J.-O. (Jan-Ola), Kiviniemi, T. O. (Tuomas O.), Lautamäki, A. (Anna), Gunn, J. M. (Jarmo M.), Airaksinen, K. E. (Kari Eino Juhani), Biancari, F. (Fausto), Kajander, O. A. (Olli A.), Anttila, V. (Vesa), Heikkinen, J. (Jouni), Eskola, M. (Markku), Ilveskoski, E. (Erkki), Mennander, A. (Ari), Korpilahti, K. (Kari), Wistbacka, J.-O. (Jan-Ola), and Kiviniemi, T. O. (Tuomas O.)

Abstract

Background: The aim of this study was to investigate the incidence of permanent working disability (PWD) in young patients after percutaneous or surgical coronary revascularization. Methods and Results: The study included 1035 consecutive patients ≤50 years old who underwent coronary revascularization [910 and 125 patients in percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) groups, respectively] between 2002 and 2012 at 4 Finnish hospitals. The median follow-up time was 41 months. The overall incidence of PWD was higher after CABG compared to PCI (at 5 years, 34.8 vs. 14.7%, P < 0.001). Freedom from PWD in the general population aged 45 was 97.2% at 4 years follow-up. Median time to grant disability pension was 11.6 months after CABG and 24.4 months after PCI (P = 0.018). Reasons for PWD were classified as cardiac (35.3 vs. 36.9%), psychiatric (14.7 vs. 14.6%), and musculoskeletal (14.7 vs. 15.5%) in patients undergoing CABG vs. PCI. Overall freedom from PWD was higher in patients without major adverse cardiac and cerebrovascular event (MACCE) (at 5 years, 85.6 vs. 71.9%, P < 0.001). Nevertheless, rate of PWD was high also in patients without MACCE and patients with preserved ejection fraction during follow-up. Conclusions: Although coronary revascularization confers good overall survival in young patients, PWD is common especially after CABG and mostly for cardiac reasons even without occurrence of MACCE. Supportive measures to preserve occupational health are warranted concomitantly with coronary revascularization at all levels of health care.

Published
2017

11. Genetic loci associated with heart rate variability and their effects on cardiac disease risk

Author

Nolte, I. M. (Ilja M.), Munoz, M. L. (M. Loretto), Tragante, V. (Vinicius), Amare, A. T. (Azmeraw T.), Jansen, R. (Rick), Vaez, A. (Ahmad), von der Heyde, B. (Benedikt), Avery, C. L. (Christy L.), Bis, J. C. (Joshua C.), Dierckx, B. (Bram), van Dongen, J. (Jenny), Gogarten, S. M. (Stephanie M.), Goyette, P. (Philippe), Hernesniemi, J. (Jussi), Huikari, V. (Ville), Hwang, S.-J. (Shih-Jen), Jaju, D. (Deepali), Kerr, K. F. (Kathleen F.), Kluttig, A. (Alexander), Krijthe, B. P. (Bouwe P.), Kumar, J. (Jitender), van der Laan, S. W. (Sander W.), Lyytikäinen, L.-P. (Leo-Pekka), Maihofer, A. X. (Adam X.), Minassian, A. (Arpi), van der Most, P. J. (Peter J.), Mueller-Nurasyid, M. (Martina), Nivard, M. (Michel), Salvi, E. (Erika), Stewart, J. D. (James D.), Thayer, J. F. (Julian F.), Verweij, N. (Niek), Wong, A. (Andrew), Zabaneh, D. (Delilah), Zafarmand, M. H. (Mohammad H.), Abdellaoui, A. (Abdel), Albarwani, S. (Sulayma), Albert, C. (Christine), Alonso, A. (Alvaro), Ashar, F. (Foram), Auvinen, J. (Juha), Axelsson, T. (Tomas), Baker, D. G. (Dewleen G.), de Bakker, P. I. (Paul I. W.), Barcella, M. (Matteo), Bayoumi, R. (Riad), Bieringa, R. J. (Rob J.), Boomsma, D. (Dorret), Boucher, G. (Gabrielle), Britton, A. R. (Annie R.), Christophersen, I. E. (Ingrid E.), Dietrich, A. (Andrea), Ehret, G. B. (George B.), Ellinor, P. T. (Patrick T.), Eskola, M. (Markku), Felix, J. F. (Janine F.), Floras, J. S. (John S.), Franco, O. H. (Oscar H.), Friberg, P. (Peter), Gademan, M. G. (Maaike G. J.), Geyer, M. A. (Mark A.), Giedraitis, V. (Vilmantas), Hartman, C. A. (Catharina A.), Hemerich, D. (Daiane), Hofman, A. (Albert), Hottenga, J.-J. (Jouke-Jan), Huikuri, H. (Heikki), Hutri-Kähönen, N. (Nina), Jouven, X. (Xavier), Junttila, J. (Juhani), Juonala, M. (Markus), Kiviniemi, A. M. (Antti M.), Kors, J. A. (Jan A.), Kumari, M. (Meena), Kuznetsova, T. (Tatiana), Laurie, C. C. (Cathy C.), Lefrandt, J. D. (Joop D.), Li, Y. (Yong), Li, Y. (Yun), Liao, D. (Duanping), Limacher, M. C. (Marian C.), Lin, H. J. (Henry J.), Lindgren, C. M. (Cecilia M.), Lubitz, S. A. (Steven A.), Mahajan, A. (Anubha), McKnight, B. (Barbara), zu Schwabedissen, H. M. (Henriette Meyer), Milaneschi, Y. (Yuri), Mononen, N. (Nina), Morris, A. P. (Andrew P.), Nalls, M. A. (Mike A.), Navis, G. (Gerjan), Neijts, M. (Melanie), Nikus, K. (Kjell), North, K. E. (Kari E.), O'Connor, D. T. (Daniel T.), Ormel, J. (Johan), Perz, S. (Siegfried), Peters, A. (Annette), Psaty, B. M. (Bruce M.), Raitakari, O. T. (Olli T.), Risbrough, V. B. (Victoria B.), Sinner, M. F. (Moritz F.), Siscovick, D. (David), Smit, J. H. (Johannes H.), Smith, N. L. (Nicholas L.), Soliman, E. Z. (Elsayed Z.), Sotoodehnia, N. (Nona), Staessen, J. A. (Jan A.), Stein, P. K. (Phyllis K.), Stilp, A. M. (Adrienne M.), Stolarz-Skrzypek, K. (Katarzyna), Strauch, K. (Konstantin), Sundström, J. (Johan), Swenne, C. A. (Cees A.), Syvänen, A.-C. (Ann-Christine), Tardif, J.-C. (Jean-Claude), Taylor, K. D. (Kent D.), Teumer, A. (Alexander), Thornton, T. A. (Timothy A.), Tinker, L. E. (Lesley E.), Uitterlinden, A. G. (Andre G.), van Setten, J. (Jessica), Voss, A. (Andreas), Waldenberger, M. (Melanie), Wilhelmsen, K. C. (Kirk C.), Willemsen, G. (Gonneke), Wong, Q. (Quenna), Zhang, Z.-M. (Zhu-Ming), Zonderman, A. B. (Alan B.), Cusi, D. (Daniele), Evans, M. K. (Michele K.), Greiser, H. K. (Halina K.), van der Harst, P. (Pim), Hassan, M. (Mohammad), Ingelsson, E. (Erik), Järvelin, M.-R. (Marjo-Riitta), Kaab, S. (Stefan), Kähönen, M. (Mika), Kivimäki, M. (Mika), Kooperberg, C. (Charles), Kuh, D. (Diana), Lehtimäki, T. (Terho), Lind, L. (Lars), Nievergelt, C. M. (Caroline M.), O'Donnell, C. J. (Chris J.), Oldehinkel, A. J. (Albertine J.), Penninx, B. (Brenda), Reiner, A. P. (Alexander P.), Riese, H. (Harriette), van Roon, A. M. (Arie M.), Rioux, J. D. (John D.), Rotter, J. I. (Jerome I.), Sofer, T. (Tamar), Stricker, B. H. (Bruno H.), Tiemeier, H. (Henning), Vrijkotte, T. G. (Tanja G. M.), Asselbergs, F. W. (Folkert W.), Brundel, B. J. (Bianca J. J. M.), Heckbert, S. R. (Susan R.), Whitsel, E. A. (Eric A.), den Hoed, M. (Marcel), Snieder, H. (Harold), de Geus, E. J. (Eco J. C.), Nolte, I. M. (Ilja M.), Munoz, M. L. (M. Loretto), Tragante, V. (Vinicius), Amare, A. T. (Azmeraw T.), Jansen, R. (Rick), Vaez, A. (Ahmad), von der Heyde, B. (Benedikt), Avery, C. L. (Christy L.), Bis, J. C. (Joshua C.), Dierckx, B. (Bram), van Dongen, J. (Jenny), Gogarten, S. M. (Stephanie M.), Goyette, P. (Philippe), Hernesniemi, J. (Jussi), Huikari, V. (Ville), Hwang, S.-J. (Shih-Jen), Jaju, D. (Deepali), Kerr, K. F. (Kathleen F.), Kluttig, A. (Alexander), Krijthe, B. P. (Bouwe P.), Kumar, J. (Jitender), van der Laan, S. W. (Sander W.), Lyytikäinen, L.-P. (Leo-Pekka), Maihofer, A. X. (Adam X.), Minassian, A. (Arpi), van der Most, P. J. (Peter J.), Mueller-Nurasyid, M. (Martina), Nivard, M. (Michel), Salvi, E. (Erika), Stewart, J. D. (James D.), Thayer, J. F. (Julian F.), Verweij, N. (Niek), Wong, A. (Andrew), Zabaneh, D. (Delilah), Zafarmand, M. H. (Mohammad H.), Abdellaoui, A. (Abdel), Albarwani, S. (Sulayma), Albert, C. (Christine), Alonso, A. (Alvaro), Ashar, F. (Foram), Auvinen, J. (Juha), Axelsson, T. (Tomas), Baker, D. G. (Dewleen G.), de Bakker, P. I. (Paul I. W.), Barcella, M. (Matteo), Bayoumi, R. (Riad), Bieringa, R. J. (Rob J.), Boomsma, D. (Dorret), Boucher, G. (Gabrielle), Britton, A. R. (Annie R.), Christophersen, I. E. (Ingrid E.), Dietrich, A. (Andrea), Ehret, G. B. (George B.), Ellinor, P. T. (Patrick T.), Eskola, M. (Markku), Felix, J. F. (Janine F.), Floras, J. S. (John S.), Franco, O. H. (Oscar H.), Friberg, P. (Peter), Gademan, M. G. (Maaike G. J.), Geyer, M. A. (Mark A.), Giedraitis, V. (Vilmantas), Hartman, C. A. (Catharina A.), Hemerich, D. (Daiane), Hofman, A. (Albert), Hottenga, J.-J. (Jouke-Jan), Huikuri, H. (Heikki), Hutri-Kähönen, N. (Nina), Jouven, X. (Xavier), Junttila, J. (Juhani), Juonala, M. (Markus), Kiviniemi, A. M. (Antti M.), Kors, J. A. (Jan A.), Kumari, M. (Meena), Kuznetsova, T. (Tatiana), Laurie, C. C. (Cathy C.), Lefrandt, J. D. (Joop D.), Li, Y. (Yong), Li, Y. (Yun), Liao, D. (Duanping), Limacher, M. C. (Marian C.), Lin, H. J. (Henry J.), Lindgren, C. M. (Cecilia M.), Lubitz, S. A. (Steven A.), Mahajan, A. (Anubha), McKnight, B. (Barbara), zu Schwabedissen, H. M. (Henriette Meyer), Milaneschi, Y. (Yuri), Mononen, N. (Nina), Morris, A. P. (Andrew P.), Nalls, M. A. (Mike A.), Navis, G. (Gerjan), Neijts, M. (Melanie), Nikus, K. (Kjell), North, K. E. (Kari E.), O'Connor, D. T. (Daniel T.), Ormel, J. (Johan), Perz, S. (Siegfried), Peters, A. (Annette), Psaty, B. M. (Bruce M.), Raitakari, O. T. (Olli T.), Risbrough, V. B. (Victoria B.), Sinner, M. F. (Moritz F.), Siscovick, D. (David), Smit, J. H. (Johannes H.), Smith, N. L. (Nicholas L.), Soliman, E. Z. (Elsayed Z.), Sotoodehnia, N. (Nona), Staessen, J. A. (Jan A.), Stein, P. K. (Phyllis K.), Stilp, A. M. (Adrienne M.), Stolarz-Skrzypek, K. (Katarzyna), Strauch, K. (Konstantin), Sundström, J. (Johan), Swenne, C. A. (Cees A.), Syvänen, A.-C. (Ann-Christine), Tardif, J.-C. (Jean-Claude), Taylor, K. D. (Kent D.), Teumer, A. (Alexander), Thornton, T. A. (Timothy A.), Tinker, L. E. (Lesley E.), Uitterlinden, A. G. (Andre G.), van Setten, J. (Jessica), Voss, A. (Andreas), Waldenberger, M. (Melanie), Wilhelmsen, K. C. (Kirk C.), Willemsen, G. (Gonneke), Wong, Q. (Quenna), Zhang, Z.-M. (Zhu-Ming), Zonderman, A. B. (Alan B.), Cusi, D. (Daniele), Evans, M. K. (Michele K.), Greiser, H. K. (Halina K.), van der Harst, P. (Pim), Hassan, M. (Mohammad), Ingelsson, E. (Erik), Järvelin, M.-R. (Marjo-Riitta), Kaab, S. (Stefan), Kähönen, M. (Mika), Kivimäki, M. (Mika), Kooperberg, C. (Charles), Kuh, D. (Diana), Lehtimäki, T. (Terho), Lind, L. (Lars), Nievergelt, C. M. (Caroline M.), O'Donnell, C. J. (Chris J.), Oldehinkel, A. J. (Albertine J.), Penninx, B. (Brenda), Reiner, A. P. (Alexander P.), Riese, H. (Harriette), van Roon, A. M. (Arie M.), Rioux, J. D. (John D.), Rotter, J. I. (Jerome I.), Sofer, T. (Tamar), Stricker, B. H. (Bruno H.), Tiemeier, H. (Henning), Vrijkotte, T. G. (Tanja G. M.), Asselbergs, F. W. (Folkert W.), Brundel, B. J. (Bianca J. J. M.), Heckbert, S. R. (Susan R.), Whitsel, E. A. (Eric A.), den Hoed, M. (Marcel), Snieder, H. (Harold), and de Geus, E. J. (Eco J. C.)

Abstract

Reduced cardiac vagal control reflected in low heart rate variability (HRV) is associated with greater risks for cardiac morbidity and mortality. In two-stage meta-analyses of genome-wide association studies for three HRV traits in up to 53,174 individuals of European ancestry, we detect 17 genome-wide significant SNPs in eight loci. HRV SNPs tag non-synonymous SNPs (in NDUFA11 and KIAA1755), expression quantitative trait loci (eQTLs) (influencing GNG11, RGS6 and NEO1), or are located in genes preferentially expressed in the sinoatrial node (GNG11, RGS6 and HCN4). Genetic risk scores account for 0.9 to 2.6% of the HRV variance. Significant genetic correlation is found for HRV with heart rate (-0.74

Published
2017

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