Krzysztof Ściborski

Objectives: The aim of this study is to evaluate the safety and efficacy of repeat transcatheter aortic valve implantation (redo-TAVI) in the polish population. Methods: In this multicentre nationwide registry (ClinicalTrials.gov identifier, NCT03361046), we provide characteristics, periprocedural variables and long-term outcomes of high-risk patients who underwent redo-TAVI. Results: The mean age among 32 individuals who underwent redo-TAVI was 75 ± 13 years, and 62.5% were male. The mean time from index TAVI to redo-TAVI was 4.7 ± 3.5 years, with failed procedures (up to 1 year) occurring in 7 (21.9%) and failed transcatheter heart valve (THV, beyond 1 year) in the remaining majority of the 25 (78.1%) patients. Computed tomography-based native bicuspid aortic anatomy was found frequently in 37.5% of cases (58.3% in failed procedures and 41.7% in failed THV). The mean failed THV size was large (27.7 ± 3 mm) and predominantly presenting with pure regurgitation (59.4%). In more than two-thirds (68.7%), balloon-expandable or self-expandable THV was the most common strategy of redo-TAVI. None or mild regurgitation was found in 90.6%, and the mean transvalvular gradient was 13.1 ± 5.5 mmHg, with only three cases with >20 mmHg of the residual gradient (9.4%). Peri-procedural and 30-day complications were low, and cardiovascular and all-cause mortality at 1 year was 9.4 and 15.6%, respectively. There was a relatively high incidence of non-procedural stroke after redo-TAVI (n = 5, 15.6%), with all cases observed after 30 days. Conclusions: Initial data of redo-TAVI in Poland suggest that the procedure is safe and characterized by favourable efficacy and low rates of short-term adverse outcomes. A high frequency of baseline native bicuspid anatomy and late stroke occurrence after the redo-procedure warrants further investigation in larger cohorts.

Background/Objectives: Quality of life (QoL) is recognized as a clinically significant outcome measure among patients with aortic stenosis (AS). However, there is no validated, AS-specific questionnaire available in Poland for assessing the QoL in AS patients. The aim of the study was to determine the psychometric properties of the Polish version of the Toronto Aortic Stenosis Quality of Life Questionnaire (the TASQ). Methods: The study involved 113 patients with severe AS (including 59 women), aged 74 to 82 years [mean age 77 years], hospitalized at the department of cardiology in 2024. The standardized questionnaires were used to assess the level of QoL, the TASQ, and the Minnesota Living with Heart Failure Questionnaire (the MLHFQ). Results: The mean QoL level assessed by the TASQ was 60.72 ± 22.82. The Cronbach’s alpha for the entire TASQ was 0.919, for the emotional impact subscale 0.873, and for the physical limitation subscale 0.861. Satisfactory values of fit measures were obtained for a five-factor structure (RMSEA < 0.01; CFI > 0.99). The loadings of each item were statistically significant (p < 0.001). The MLHFQ score correlated significantly (p < 0.001) and positively (r > 0) with the score on the scales of physical symptoms (r = 0.479), physical limitations (r = 0.662), social limitations (r = 0.597), emotional impact (r = 0.638), and overall QoL (r = 0.712). Conclusions: Patients with severe AS exhibit low QoL. The TASQ has very good psychometric properties and can be used to assess the QoL in the population of Polish patients with AS.

Background. The nutritional status of patients in hospitals has a significant impact on the effectiveness of treatment, the occurrence of complications, and the length of hospitalization. The purpose of this study was to evaluate the nutritional status of patients with heart failure (HF) and its impact on patient outcomes. Material and Methods. This study included 213 patients (153 men, 71.8%) aged 74.7 ± 14.3 years treated for HF at the cardiology clinic of the 4th Military Clinical Hospital between 2018 and 2021. Sociodemographics, clinical data, the Model for End-Stage Liver Disease (MELD), CHILD-PUGH, and the Nutritional Risk Score (NRS) were analyzed. Results. Patients at high nutritional risk (NRS ≥ 3 score) were older (85 years vs. 75 years; p < 0.001), had longer hospitalizations (12 days vs. 9 days, p = 0.027), lower hemoglobin (10.5 g/dL vs. 11.7 g/dL, p = 0.001), lower TIBC (292 vs. 336; p = 0.012), and iron (32 mg/nL vs. 39 ng/mL, p = 0.009) compared with patients at low risk (NRS < 3 score). Patients hospitalized ≤7 days had significantly lower CHILD-PUGH score compared with patients hospitalized >7 days. Patients hospitalized ≥14 days were significantly more likely to die compared with other groups of HF patients (10.6% vs. 0.0%, p = 0.004). Conclusions. Abnormal nutritional status among hospitalized HF patients is associated with longer hospitalization duration and higher rates of death. In addition to clinical factors, the CHILD-PUGH scale can be helpful in estimating the length of hospitalization of HF patients. It is necessary to determine the impact of nutritional status on the outcome of patients with heart failure in further multicenter prospective or interventional studies.

Backround/Objectives: Aortic stenosis (AS) is the most commonly acquired valvular disorder. Patient risk stratification and the development of an accurate and reliable tool are crucial in identifying suitable candidates for TAVI. The present review summarized the current state of knowledge on the influence of selected factors on the outcomes and course of patients with AS undergoing transcatheter aortic valve implantation (TAVI). Methods: The inclusion criteria for the present systematic review were as follows: (1) studies indexed in the medical databases PubMed, MEDLINE, EMBASE, CINAHL, Web of Science, and Scopus; (2) full-text articles available in English; (3) papers published between 2013 and 2023; and (4) addressing the topic of assessing the impact of factors on the outcomes of patients with aortic stenosis undergoing TAVI. This review used PRISMA 2020 reporting guidelines for systematic reviews and meta-analyses. Results: One hundred and thirty-two studies were eligible for this review. The available studies showed an association of psychosocial and socioeconomic factors, valve parameters, comorbidities, clinical factors, treatment-related factors, biomarkers, and treatment methods with the outcomes of patients with AS undergoing TAVI. Conclusions: Given the conflicting results obtained regarding the impact of right ventricular dysfunction, paravalvular leaks, and treatment method on the mortality of patients undergoing aortic valve implantation, further research in these areas is needed. In view of the researchers’ differing views on some of the factors affecting patient outcomes after TAVI, further analysis is needed to develop a new tool for assessing predictive outcomes in AS patients. This study is registered at PROSPERO (CRD42024612752).

DOI: 10.33963/KP.15738, Published online: January 04, 2021, Authors: Krzysztof Ściborski, Michał Furdal, Marek Mak, Katarzyna Wojciechowska, Maciej Banasiak, Agnieszka Wysokińska-Kordybach, Waldemar Banasiak, Artur Telichowski

DOI: 10.20452/pamw.15282, Published online: April 06, 2020, Authors: Krzysztof Ściborski, Marek Gierlotka, Marcin Protasiewicz, Bożena Karolko, Marta Negrusz-Kawecka, Wiktor Kuliczkowski