26
|
Forrest JK, Mangi AA, Popma JJ, Khabbaz K, Reardon MJ, Kleiman NS, Yakubov SJ, Watson D, Kodali S, George I, Tadros P, Zorn GL, Brown J, Kipperman R, Saul S, Qiao H, Oh JK, Williams MR. Early Outcomes With the Evolut PRO Repositionable Self-Expanding Transcatheter Aortic Valve With Pericardial Wrap. JACC Cardiovasc Interv 2018; 11:160-168. [DOI: 10.1016/j.jcin.2017.10.014] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 11/29/2022]
|
27
|
Kleiman NS, Maini BJ, Reardon MJ, Conte J, Katz S, Rajagopal V, Kauten J, Hartman A, McKay R, Hagberg R, Huang J, Popma J, Ad N, Aharonian V, Anderson WD, Applegate R, Bafi A, Bajwa T, Bakhos M, Ball S, Batra S, Beohar N, Brachinsky W, Brinster D, Brown J, Byrne J, Byrne T, Casale A, Caskey M, Chawla A, Cohen H, Coselli J, Costa M, Cheatham J, Chetcuti SJ, Crestanello J, Davis T, Michael Deeb G, Diez J, Dauerman H, Elefteriades J, Fail P, Feinberg E, Fontana G, Forrest JL, Galloway A, Giacomini J, Gleason TG, Guadiani V, Harrison JK, Hebeler R, Heimansohn D, Heiser J, Heller L, Henry S, Hermiller J, Hockmuth D, Hughes GC, Joye J, Kafi A, Kar B, Khabbaz K, Kipperman R, Kliger C, Kon N, Lamelas J, Lee JS, Leya F, Londono JC, Macheers S, Mangi A, de Marchena E, Markowitz A, Matthews R, Merhi W, Mumtaz M, O’Hair D, Petrossian G, Pfeffer T, Raybuck B, Resar J, Robbins M, Robbins R, Robinson N, Ring M, Salerno T, Schreiber T, Schmoker J, Sharma S, Siwek L, Skelding K, Slater J, Starnes V, Stoler R, Subramanian V, Tadros P, Thompson C, Waksman R, Watson D, Yakubov S, Zhao D, Zorn GL. Neurological Events Following Transcatheter Aortic Valve Replacement and Their Predictors: A Report From the CoreValve Trials. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003551. [PMID: 27601429 DOI: 10.1161/circinterventions.115.003551] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 07/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The risk for stroke after transcatheter aortic valve replacement (TAVR) is an important concern. Identification of predictors for stroke is likely to be a critical factor aiding patient selection and management as TAVR use becomes widespread. METHODS AND RESULTS Patients enrolled in the CoreValve US Extreme Risk and High Risk Pivotal Trials or Continued Access Study treated with the self-expanding CoreValve bioprosthesis were included in this analysis. The 1-year stroke rate after TAVR was 8.4%. Analysis of the stroke hazard rate identified an early phase (0-10 days; 4.1% of strokes) and a late phase (11-365 days; 4.3% of strokes). Baseline predictors of early stroke included National Institutes of Health stroke scale score >0, prior stroke, prior transient ischemic attack, peripheral vascular disease, absence of prior coronary artery bypass surgery, angina, low body mass index (<21 kg/m(2)), and falls within the past 6 months. Significant procedural predictors were total time in the catheterization laboratory or operating room, delivery catheter in the body time, rapid pacing used during valvuloplasty, and repositioning of the prosthesis. Predictors of stroke between 11 and 365 days were small body surface area, severe aortic calcification, and falls within the past 6 months. There were no significant imaging predictors of early or late stroke. CONCLUSIONS Predictors of early stroke after TAVR included clinical and procedural factors; predictors of later stroke were limited to patient but not anatomic characteristics. These findings indicate that further refinement of imaging to identify anatomic factors predisposing to embolization may help improve stroke prediction in patients undergoing TAVR. CLINICAL TRIAL REGISTRATIONS URL: http://www.clinicaltrials.gov. Unique identifiers: NCT01240902, NCT01531374.
Collapse
|
28
|
Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad P, Hammamo S, Dawn B, Wiley M, Weintraub W, Doorey A, Tadros P. P1636Utility and safety of pressure wires use in hemodynamic assessment of paradoxical low flow low gradient aortic stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
29
|
Fanari Z, Gunasekaran P, Shaukat A, Wiley M, Dawn B, Weintraub W, Tadros P, Marshall E. P1646Paradoxical low flow low gradient severe aortic stenosis with preserved left ventricular ejection fraction. impact of medical, transcatheter and surgical management. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Lippmann M, Patel J, Kvapil J, Westover D, Pierpoline M, Tadros P, Wiley M, Zorn G, Muehlebach G, Mehta A, Hockstad E, Earnest M, Gupta K. Safety and Feasibility of Rotational Atherectomy in Elderly Patients With Severe Aortic Stenosis. THE JOURNAL OF INVASIVE CARDIOLOGY 2017; 29:271-275. [PMID: 28756420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) followed by transcatheter aortic valve replacement (TAVR) is an alternative to surgery in patients with severe aortic stenosis (AS) and coronary artery disease (CAD). In many, the coronary arteries are severely calcified and best treated with rotational atherectomy (RA). However, RA is not routinely performed in severe AS patients due to safety concerns. There is a paucity of data on the safety of RA in severe AS patients with calcific CAD. METHODS We retrospectively analyzed the medical records of 29 patients with severe AS who underwent elective RA-facilitated PCI at our center between January 1, 2011 and December 31, 2015. RESULTS Twenty-nine patients (mean age, 79.8 ± 8.8 years) were enrolled. Mean aortic valve area was 0.71 ± 0.20 cm², mean aortic valve gradient was 40.32 ± 9.88 mm Hg. All PCIs were successful (mean diameter stenosis, 86.3 ± 7.6%; mean burr size, 1.62 ± 0.19 mm). Nineteen patients (65.5%) required temporary pacemaker. Eight patients (27.6%) required vasopressors during PCI. There was a significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during RA, but without clinical events. No procedure was aborted and there were no deaths or clinical myocardial infarctions. CONCLUSION RA-facilitated PCI can be safely performed in elderly patients with severe AS and severely calcified CAD with low risk of complications. There was a significant but transient drop in SBP, DBP, MAP, and HR during RA. However, this was not associated with clinically significant adverse events.
Collapse
|
31
|
Forrest JK, Mangi A, Popma J, Khabbaz K, Reardon M, Kleiman N, Yakubov S, Watson D, Kodali S, George I, Tadros P, Zorn G, Brown J, Kipperman R, Staniloae C, Williams M. INITIAL USE OF THE EVOLUT PRO SELF-EXPANDING TRANSCATHETER AORTIC VALVE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34677-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Lippmann M, Patel J, Kvapil J, Pierpoline M, Tadros P, Wiley M, Earnest M, Mehta A, Hockstad E, Gupta K. SAFETY AND FEASIBILITY OF ROTATIONAL ATHERECTOMY IN ELDERLY PATIENTS WITH SEVERE AORTIC STENOSIS AND CALCIFIC CORONARY ARTERY DISEASE UNDERGOING EVALUATION FOR TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
33
|
Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad K, Hammami S, West J, Wiley M, Dawn B, Weintraub W, Tadros P, Doorey AJ. HEMODYNAMIC ASSESSMENT OF LOW FLOW, LOW GRADIENT SEVERE AORTIC STENOSIS WITH PRESERVED EF USING A PRESSURE WIRE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34631-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
34
|
Fanari Z, Gunasekaran P, Thapa J, Shaukat A, Persad K, Hammami S, Wiley M, Dawn B, West J, Weintraub W, Doorey A, Tadros P. THE IMPACT OF TRANSAORTIC GRADIENT AND TRANSAORTIC FLOW ON THE DISCREPANCY BETWEEN ECHOCARDIOGRAPHIC AND CARDIAC CATHETERIZATION EVALUATION OF SEVERE AORTIC STENOSIS WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34653-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
35
|
Fanari Z, Shaukat A, Gunasekaran P, Hammami S, Dawn B, Wiley M, Tadros P. CRT-800.16 Utility Of Dobutamine and Pressure Wire Use in Assessing Low Flow Low Gradient Aortic Stenosis With Reduced EF. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
36
|
Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad K, Hammami S, Weintraub W, Dawn B, Wiley M, Doorey A, Tadros P. CRT-800.10 Safety and Efficacy of Pressure Wire Use in Hemodynamic Assessment of Paradoxical Low Flow Low Gradient Aortic Stenosis. JACC Cardiovasc Interv 2017. [DOI: 10.1016/j.jcin.2016.12.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
37
|
Stanojevic D, Gunasekaran P, Tadros P, Wiley M, Earnest M, Mehta A, Lippmann M, Levine M, Dawn B, Gupta K. Intravenous Adenosine Infusion is Safe and Well Tolerated During Coronary Fractional Flow Reserve Assessment in Elderly Patients With Severe Aortic Stenosis. THE JOURNAL OF INVASIVE CARDIOLOGY 2016; 28:357-361. [PMID: 27315577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND This study assessed the safety of intravenous adenosine infusion during fractional flow reserve (FFR) evaluation of intermediate coronary lesions in severe aortic stenosis (AS). In severe AS, the extent of underlying coronary artery disease (CAD) can be an important determinant for deciding between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). Hemodynamic assessment of coronary lesion severity using FFR may reduce the extent of revascularization needed and make TAVR more feasible in higher-risk patients (compared with coronary artery bypass surgery with SAVR). METHODS AND RESULTS We retrospectively analyzed the demographic, clinical, and hemodynamic parameters of 72 patients with severe AS who underwent FFR procedure with intravenous adenosine infusion for hemodynamic assessment of intermediate coronary artery lesions. Severe AS patients were elderly, predominantly male, and had a high prevalence of peripheral arterial disease, prior myocardial infarction, left ventricular hypertrophy, and chronic kidney disease. Mean aortic valve area in these patients was 0.71 ± 0.24 cm². No patient with severe AS required discontinuation of the adenosine and all patients tolerated the infusion well. We observed a statistically significant reduction in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) during adenosine infusion compared with the baseline values. However, no clinically significant adverse events occurred. CONCLUSION In elderly patients with severe AS, adenosine infusion is safe and well tolerated during FFR evaluation of intermediate coronary lesions. There was a significantly greater drop in SBP, DBP, MAP, and HR with adenosine infusion as compared with baseline values. This, however, was not associated with clinically significant adverse events.
Collapse
|
38
|
Deeb GM, Reardon MJ, Chetcuti S, Patel HJ, Grossman PM, Yakubov SJ, Kleiman NS, Coselli JS, Gleason TG, Lee JS, Hermiller JB, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte J, Resar J, Aharonian V, Pfeffer T, Oh JK, Qiao H, Adams DH, Popma JJ. 3-Year Outcomes in High-Risk Patients Who Underwent Surgical or Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2016; 67:2565-74. [DOI: 10.1016/j.jacc.2016.03.506] [Citation(s) in RCA: 252] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022]
|
39
|
Tobbia P, Kimber C, Jang B, Levine M, Abdoullayev A, Funk R, Jacobs D, Wiley M, Mehta A, Earnest M, Tadros P, Dawn B, Gupta K. THE ROLE OF REMOTE ISCHEMIC PRECONDITIONING IN THE PREVENTION OF CONTRAST INDUCED NEPHROPATHY. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32349-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
40
|
Shah Z, Masoomi R, Tadros P. Managing Antiplatelet Therapy and Anticoagulants in Patients with Coronary Artery Disease and Atrial Fibrillation. J Atr Fibrillation 2015; 8:1318. [PMID: 27957230 DOI: 10.4022/jafib.1318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/09/2015] [Accepted: 10/27/2015] [Indexed: 01/15/2023]
Abstract
Oral anticoagulation (OAC) is essential in patients with atrial fibrillation (AF). Interestingly coronary artery disease coexists in 20-30% of these patients.[1,2] Balancing the risk of bleeding and thromboembolism is very important for the management of patients on OAC, especially than when such patients require percutaneous coronary intervention (PCI). Lack of data and clear societal guidelines for peri-procedural and post-procedural management of anticoagulated patients has resulted in diverse clinical practices among clinicians, hospitals, and countries. Furthermore with expanding number of available oral antiplatelet and anticoagulant agents, the uncertainty regarding optimal combination therapy in this growing pool of the patients with overlapping clinical indications is also growing. Given the high proportion of patients with atherothrombosis and requiring OAC for conditions particularly like AF, it is important that physicians are aware of the clinical implications and management of these overlapping syndromes. In this article we discuss; this evolving dilemma of peri-procedural and post-procedural management of anticoagulated patient's, burden of the disease, available data, risk factors that could identify high risk patients and propose a well-balanced management strategy.
Collapse
|
41
|
Reardon MJ, Adams DH, Kleiman NS, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Lee JS, Hermiller JB, Chetcuti S, Heiser J, Merhi W, Zorn GL, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Maini B, Mumtaz M, Conte JV, Resar JR, Aharonian V, Pfeffer T, Oh JK, Qiao H, Popma JJ. 2-Year Outcomes in Patients Undergoing Surgical or Self-Expanding Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2015; 66:113-21. [PMID: 26055947 DOI: 10.1016/j.jacc.2015.05.017] [Citation(s) in RCA: 326] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 04/21/2015] [Accepted: 05/05/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND The U.S. pivotal trial for the self-expanding valve found that among patients with severe aortic stenosis at increased risk for surgery, the 1-year survival rate was 4.9 percentage points higher in patients treated with a self-expanding transcatheter aortic valve bioprosthesis than in those treated with a surgical bioprosthesis. OBJECTIVES Longer-term clinical outcomes were examined to confirm if this mortality benefit is sustained. METHODS Patients with severe aortic stenosis who were at increased surgical risk were recruited. Eligible patients were randomly assigned in a 1:1 ratio to transcatheter aortic valve replacement with the self-expanding transcatheter valve (transcatheter aortic valve replacement [TAVR] group) or to aortic valve replacement with a surgical bioprosthesis (surgical group). The 2-year clinical and echocardiographic outcomes were evaluated in these patients. RESULTS A total of 797 patients underwent randomization at 45 centers in the United States. The rate of 2-year all-cause mortality was significantly lower in the TAVR group (22.2%) than in the surgical group (28.6%; log-rank test p < 0.05) in the as-treated cohort, with an absolute reduction in risk of 6.5 percentage points. Similar results were found in the intention-to-treat cohort (log-rank test p < 0.05). The rate of 2-year death or major stroke was significantly lower in the TAVR group (24.2%) than in the surgical group (32.5%; log-rank test p = 0.01). CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk, the higher rate of survival with a self-expanding TAVR compared with surgery was sustained at 2 years. (Safety and Efficacy Study of the Medtronic CoreValve System in the Treatment of Symptomatic Severe Aortic Stenosis in High Risk and Very High Risk Subjects Who Need Aortic Valve Replacement; NCT01240902).
Collapse
|
42
|
Arnold S, Reynolds M, Wang K, Magnuson E, Baron S, Chinnakondepalli K, Reardon M, Tadros P, Zorn G, Maini B, Mumtaz M, Brown J, Kipperman R, Adams D, Popma J, Cohen D. HEALTH STATUS AFTER TRANSCATHETER OR SURGICAL AORTIC VALVE REPLACEMENT IN HIGH-RISK PATIENTS WITH SEVERE AORTIC STENOSIS: RESULTS FROM THE COREVALVE US PIVOTAL TRIAL. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
43
|
Stanojevic DA, Gunasekaran P, Levine M, Reichuber M, Genton R, Mehta A, Earnest M, Wiley M, Tadros P, Dawn B, Gupta K. INTRAVENOUS ADENOSINE INFUSION IS SAFE AND WELL TOLERATED DURING CORONARY FRACTIONAL FLOW RESERVE ASSESSMENT IN SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61931-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
44
|
Jeevanantham V, Chehab B, Austria E, Shrivastava R, Wiley M, Tadros P, Dawn B, Vacek JL, Gupta K. Comparison of accuracy of two different methods to determine ankle-brachial index to predict peripheral arterial disease severity confirmed by angiography. Am J Cardiol 2014; 114:1105-10. [PMID: 25129876 DOI: 10.1016/j.amjcard.2014.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
Ankle-brachial index (ABI) is conventionally derived as the ratio of higher of the 2 systolic ankle blood pressures to the higher brachial pressure (HABI method). Alternatively, ABI may be derived using the lower of the 2 systolic ankle pressures (LABI method). The objective of this study was to assess the utility and difference between 2 techniques in predicting peripheral artery disease (PAD). Participants who underwent both ABI measurement and arteriography from July 2005 to June 2010 were reviewed. Angiographic disease burden was scored semiquantitatively (0=<50%, 1=50% to 75%, and 2=>75% stenosis of any lower extremity arterial segment), and PAD by angiography was defined as >50% stenosis of any 1 lower extremity arterial segment. A combined PAD disease score was calculated for each leg. A total of 130 patients were enrolled (260 limbs). The ABI was <0.9 (abnormal) in 68% of patients by HABI method and in 84% by LABI. LABI method had higher sensitivity and overall accuracy to detect PAD compared with the HABI method. Regression analysis showed that an abnormal ABI detected by LABI method is more likely to predict angiographic PAD and total PAD burden compared with HABI. Moreover, abnormal ABI by LABI method had higher sensitivity and accuracy to detect PAD in patients with diabetes and below knee PAD compared with the HABI method. In conclusion, ABI determined by the LABI method has higher sensitivity and is a better predictor of PAD compared with the conventional (HABI) method.
Collapse
|
45
|
Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 2014; 370:1790-8. [PMID: 24678937 DOI: 10.1056/nejmoa1400590] [Citation(s) in RCA: 2072] [Impact Index Per Article: 207.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND We compared transcatheter aortic-valve replacement (TAVR), using a self-expanding transcatheter aortic-valve bioprosthesis, with surgical aortic-valve replacement in patients with severe aortic stenosis and an increased risk of death during surgery. METHODS We recruited patients with severe aortic stenosis who were at increased surgical risk as determined by the heart team at each study center. Risk assessment included the Society of Thoracic Surgeons Predictor Risk of Mortality estimate and consideration of other key risk factors. Eligible patients were randomly assigned in a 1:1 ratio to TAVR with the self-expanding transcatheter valve (TAVR group) or to surgical aortic-valve replacement (surgical group). The primary end point was the rate of death from any cause at 1 year, evaluated with the use of both noninferiority and superiority testing. RESULTS A total of 795 patients underwent randomization at 45 centers in the United States. In the as-treated analysis, the rate of death from any cause at 1 year was significantly lower in the TAVR group than in the surgical group (14.2% vs. 19.1%), with an absolute reduction in risk of 4.9 percentage points (upper boundary of the 95% confidence interval, -0.4; P<0.001 for noninferiority; P = 0.04 for superiority). The results were similar in the intention-to-treat analysis. In a hierarchical testing procedure, TAVR was noninferior with respect to echocardiographic indexes of valve stenosis, functional status, and quality of life. Exploratory analyses suggested a reduction in the rate of major adverse cardiovascular and cerebrovascular events and no increase in the risk of stroke. CONCLUSIONS In patients with severe aortic stenosis who are at increased surgical risk, TAVR with a self-expanding transcatheter aortic-valve bioprosthesis was associated with a significantly higher rate of survival at 1 year than surgical aortic-valve replacement. (Funded by Medtronic; U.S. CoreValve High Risk Study ClinicalTrials.gov number, NCT01240902.).
Collapse
|
46
|
Matthew Shurtleff E, Vanderhyde M, Fitzwater F, Chehab B, Maletsky L, Vamanan K, Thomas P, Tadros P, Gupta K. CONFORMATIONAL CHANGES IN COMMERCIALLY AVAILABLE NITINOL STENTS IMPLANTED IN THE FEMORO–POPLITEAL ARTERIAL SEGMENT IN A CADAVERIC MODEL. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61806-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Jeevanantham V, Chehab B, Shrivastava R, Wiley M, Tadros P, Nath J, Dawn B, Gupta K. UTILITY OF TWO METHODS OF CALCULATING ANKLE BRACHIAL INDEX IN DETECTING BELOW KNEE PERIPHERAL ARTERIAL DISEASE CONFIRMED BY ANGIOGRAPHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)62075-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
48
|
Stanojevic DA, Sharma S, Jeevanantham V, Chehab B, McCullough M, Tadros P, Dawn B, Wiley M. EVALUATION OF MICRO CORONARY EDGE DISSECTION AND CORONARY ARTERY PLAQUE PROLAPSE POST CORONARY ARTERY PERCUTANEOUS INTERVENTION USING OPTICAL COHERENCE TOMOGRAPHY. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61875-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
49
|
Chehab BM, Jeevanantham V, Saad A, Vacek J, Gupta K, Dawn B, Tadros P, Wiley M. FEASIBILITY, SAFETY, AND OUTCOMES WITH A CORONARY PRESSURE WIRE SYSTEM USED FOR THE ASSESSMENT OF SEVERE AORTIC STENOSIS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60135-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
50
|
Chehab BM, Jeevanantham V, Nagavalli S, Austria E, Shrivastava R, Wiley M, Tadros P, Nath J, Dawn B, Gupta K. TWO METHODS OF CALCULATING ANKLE BRACHIAL INDEX: DIFFERENCES IN PREDICTING PERIPHERAL ARTERIAL DISEASE BURDEN. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)62128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|