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Zhou X, Duan X, Shao L, Tan N, Zuo S, Shan H, Li G, Du X, Shrestha UD, Ke T, Zhou F, Ma H, Xu Y, Ouyang Z, Liao C. Global Cost-Effectiveness of Transcatheter vs. Surgical Aortic Valve Replacement in Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. Can J Cardiol 2024:S0828-282X(24)01025-0. [PMID: 39419200 DOI: 10.1016/j.cjca.2024.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 09/30/2024] [Accepted: 10/06/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUD Transcatheter aortic valve replacement (TAVR) is a less invasive treatment option for patients with severe aortic stenosis (AS); however, its economic benefits in patients with low to intermediate surgical risk remain controversial and vary by country. We conducted a systematic review to compare the economic benefits of TAVR versus surgical aortic valve replacement (SAVR). METHODS We searched six databases, including PubMed, Medline, Scopus, Web of Science, Embase, and Clinical Trials for randomized controlled trials on the economic benefits of TAVR with different valve types and SAVR in symptomatic AS patients with low to intermediate surgical risk, from inception to October 2023. We extracted data on quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), with ICER converted to 2023 United States dollars (USD) exchange rates. RESULTS Fifteen studies met the inclusion criteria, with the overall quality ranging from intermediate to high. Among these, TAVR was found to be cost-effective in 14 studies, while in one study conducted in a developing country, TAVR was not cost-effective. When adjusted to 2023 USD, the ICER values ranged from $3,669 to $340,038 per QALY gained. CONCLUSION TAVR appears to be a cost-effective alternative to SAVR in patients with low to intermediate AS. In all studies, TAVR was associated with a significant increase in QALYs compared to SAVR. As it is an expensive procedure, the cost-effectiveness of TAVR depends on each country's ICER and willingness-to-pay threshold.
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Affiliation(s)
- Xinyan Zhou
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Xirui Duan
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Lishi Shao
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Na Tan
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Shuaiyan Zuo
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Haiyan Shan
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Guocheng Li
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Xiaolan Du
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Ujen Duwal Shrestha
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Tengfei Ke
- Yunnan Cancer Hospital (The Third Affiliated Hospital of Kunming Medical University), Department of Radiology, Kunming, China
| | - Feifei Zhou
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Han Ma
- The Third People's Hospital of Yunnan Province (The Second Affiliated Hospital of Dali University), Department of Radiology, Kunming, China
| | - Yiming Xu
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China
| | - Zhiqiang Ouyang
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China.
| | - Chengde Liao
- Kunming Yan'an Hospital (Yan'an Hospital Affiliated to Kunming Medical University), Department of Radiology, Kunming, China.
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Jørgensen TH, Thyregod HGH, Savontaus M, Willemen Y, Bleie Ø, Tang M, Niemela M, Angerås O, Gudmundsdóttir IJ, Sartipy U, Dagnegaard H, Laine M, Rück A, Piuhola J, Petursson P, Christiansen EH, Malmberg M, Olsen PS, Haaverstad R, Sondergaard L, De Backer O. Transcatheter aortic valve implantation in low-risk tricuspid or bicuspid aortic stenosis: the NOTION-2 trial. Eur Heart J 2024; 45:3804-3814. [PMID: 38747246 DOI: 10.1093/eurheartj/ehae331] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Revised: 05/07/2024] [Accepted: 05/14/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve implantation (TAVI) has become the first choice to treat older patients with severe symptomatic aortic stenosis (AS). This study aimed to compare TAVI with surgery in low-risk patients ≤75 years of age, including both tricuspid and bicuspid AS. METHODS The Nordic Aortic Valve Intervention (NOTION)-2 trial enrolled and 1:1 randomized low-risk patients aged ≤75 years with severe symptomatic AS to TAVI or surgery. The primary endpoint was a composite of all-cause mortality, stroke, or rehospitalization (related to the procedure, valve, or heart failure) at 12 months. RESULTS A total of 370 patients were enrolled with a mean age of 71.1 years and a median Society of Thoracic Surgeons risk score of 1.1%. A total of 100 patients had bicuspid AS. The 1-year incidence of the primary endpoint was 10.2% in the TAVI group and 7.1% in the surgery group [absolute risk difference 3.1%; 95% confidence interval (CI), -2.7% to 8.8%; hazard ratio (HR) 1.4; 95% CI, 0.7-2.9; P = .3]. Patients with TAVI, when compared to surgery, had lower risk of major bleeding and new-onset atrial fibrillation and higher risk of non-disabling stroke, permanent pacemaker implantation, and moderate or greater paravalvular regurgitation. The risk of the primary composite endpoint was 8.7% and 8.3% in patients with tricuspid AS (HR 1.0; 95% CI, 0.5-2.3) and 14.3% and 3.9% in patients with bicuspid AS (HR 3.8; 95% CI, 0.8-18.5) treated with TAVI or surgery, respectively (P for interaction = .1). CONCLUSIONS Among low-risk patients aged ≤75 years with severe symptomatic AS, the rate of the composite of death, stroke, or rehospitalization at 1 year was similar between TAVI and surgery. Transcatheter aortic valve implantation outcomes in young bicuspid AS patients warrant caution and should be further investigated. (NOTION-2, ClinicalTrials.gov, NCT02825134). TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT02825134.
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Affiliation(s)
| | | | - Mikko Savontaus
- Department of Cardiology and Cardiothoracic Surgery, Turku University Hospital, Turku, Finland
| | - Yannick Willemen
- Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Øyvind Bleie
- Department of Cardiology and Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway
| | - Mariann Tang
- Skejby, Aarhus University Hospital, Aarhus, Denmark
| | - Matti Niemela
- Department of Cardiology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Oskar Angerås
- Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Ulrik Sartipy
- Department of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Hanna Dagnegaard
- Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Mika Laine
- Department of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Andreas Rück
- Department of Cardiology and Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jarkko Piuhola
- Department of Cardiology, Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden
| | | | - Markus Malmberg
- Department of Cardiology and Cardiothoracic Surgery, Turku University Hospital, Turku, Finland
| | - Peter Skov Olsen
- Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Rune Haaverstad
- Department of Cardiology and Cardiothoracic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
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Connolly JE, Andabili SHA, Joseph E, Resar J, Rahman F. Transcatheter Aortic Valve Replacement in Low-Risk Patients at Four or More Years. Am J Med 2024; 137:1008-1011.e1. [PMID: 38876333 DOI: 10.1016/j.amjmed.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/20/2024] [Accepted: 05/26/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is accepted as an alternative to surgical aortic valve replacement (SAVR) in patients with severe symptomatic aortic valve stenosis. Prior studies have shown that TAVR has comparable or superior outcomes to SAVR in intermediate and high-risk patients. However, there is paucity of data about outcome of TAVR vs SAVR in low-surgical-risk patients evaluated at 4 or more years post-procedure. METHODS A systematic review of all published randomized controlled trials comparing TAVR and SAVR in low-risk patients was completed. A random-effects model meta-analysis was performed to study major outcomes, including all-cause mortality, stroke, myocardial infarction, and aortic valve reintervention. RESULTS Three randomized trials comprising 2644 patients (1371 TAVR and 1273 SAVR) with a mean age of 74.3 ± 5.8 years were included in this analysis. There was no significant difference in all-cause and cardiovascular mortality, stroke, myocardial infarction, or aortic valve reintervention between the TAVR and SAVR groups at long-term follow-up. Transcatheter aortic valve replacement was associated with higher rate of pacemaker implantation, whereas SAVR was associated with more atrial fibrillation. CONCLUSIONS At 4 or more years of follow-up, TAVR is safe and has comparable outcomes to SAVR in low-surgical-risk patients. Possibility of TAVR and its risks and benefits should be discussed with low-surgical-risk patients.
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Affiliation(s)
- John E Connolly
- Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md
| | | | - Emily Joseph
- Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md
| | - Jon Resar
- Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md
| | - Faisal Rahman
- Department of Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Md.
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Ahmad D, Dawes A, Im M, Vishnevsky A, Ruggiero NJ, Plestis KA, Massey HT, Morris RJ, Entwistle JW, Tchantchaleishvili V. Comparative Outcomes of Surgical and Transcatheter Aortic Valve Replacement: A Meta-Analysis and Parametric Extrapolation of Clinical Trials. J Surg Res 2024; 302:1-11. [PMID: 39067157 DOI: 10.1016/j.jss.2024.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 05/29/2024] [Accepted: 06/30/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION We aimed to pool randomized clinical trials (RCTs) comparing surgical aortic valve replacement (SAVR) with transcatheter aortic valve replacement (TAVR) and extrapolate pooled time-to-event data to compare long-term outcomes. METHODS An electronic database search was performed for RCTs comparing SAVR with TAVR. The most current longest follow-up data for each RCT were included. Data were pooled using a random-effects model. Survival data were pooled for Kaplan-Meier analysis as well as parametric modeling with extrapolation. RESULTS Seven RCTs comprising 7774 patients were included. Mean valve gradient at 5 y was comparable between SAVR [11 mmHg (3.7; 18.3)] and TAVR [8.1 mmHg (1.9; 14.3)] (P = 0.38). TAVR had a higher mean valve area at 30 d, 1 y, and 2 y [1.68 cm2 (1.22; 2.13) versus 1.8 cm2 (1.35; 2.25), P = 0.02]. SAVR had a higher freedom from any paravalvular leak at 30 d and 1 y [86% (81; 90) versus 39% (36; 41), P < 0.01]. All-cause death was lower in the SAVR group at 5 y [39% (29; 50) versus 43% (31; 57), P < 0.01]. Although no differences were seen between SAVR and TAVR in the pooled Kaplan-Meier analysis of all-cause mortality and composite of all-cause mortality or stroke, parametric modeling with extrapolation showed significant divergence for both outcomes. CONCLUSIONS Pooled all-cause mortality as well as pooled composite of all-cause mortality or stroke indicated better survival with SAVR at 5 y. Long-term parametric extrapolation also indicated superior survival with SAVR.
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Affiliation(s)
- Danial Ahmad
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alex Dawes
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Moses Im
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Alec Vishnevsky
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicholas J Ruggiero
- Division of Cardiology, Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Konstadinos A Plestis
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Howard T Massey
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Rohinton J Morris
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John W Entwistle
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Vakhtang Tchantchaleishvili
- Division of Cardiac Surgery, Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Asta L, Sbrigata A, Pisano C. Sutureless Aortic Prosthesis Valves versus Transcatheter Aortic Valve Implantation in Intermediate Risk Patients with Severe Aortic Stenosis: A Literature Review. J Clin Med 2024; 13:5592. [PMID: 39337078 PMCID: PMC11433614 DOI: 10.3390/jcm13185592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/31/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
Aortic stenosis remains the most frequently occurring valvular pathology in the elderly population of Western countries. According to the latest guidelines, the therapeutic choice of aortic stenosis depends on the age of the patient (<75 years or >75 years) and the risk class (STS-Prom/Euroscore II < o >4%). Therefore, if the surgical indication is clear in young and low-risk patients and percutaneous treatment is the gold standard in older and high-risk patients, the therapeutic choice is still debated in intermediate-risk patients. In this group of patients, aortic valve stenosis treatment depends on the patient's global evaluation, the experience of the center, and, no less importantly, the patient's will. Two main therapeutic options are debated: surgical aortic valve replacement with sutureless prosthesis versus transcatheter aortic valve implantation. In addition, the progressive development of mininvasive techniques for aortic valve surgery (right-anterior minithoracotomy) has also reduced the peri- and post-operative risk in this group of patients. The purpose of this review is to compare sutureless aortic valve replacement (SuAVR) versus TAVI in intermediate-risk patients with severe aortic stenosis.
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Affiliation(s)
- Laura Asta
- Department of Cardiac Surgery, Clinical Mediterranean, 80122 Naples, Italy;
| | - Adriana Sbrigata
- Cardiac Surgery Unit, Department of Precision Medicine in Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo, 90134 Palermo, Italy;
| | - Calogera Pisano
- Cardiac Surgery Unit, Department of Precision Medicine in Medical Surgical and Critical Area (Me.Pre.C.C.), University of Palermo, 90134 Palermo, Italy;
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6
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Yokoyama Y, Shimoda T, Sloan B, Takagi H, Fukuhara S, Kuno T. Meta-analysis of phase-specific survival after transcatheter versus surgical aortic valve replacement from randomized control trials. J Thorac Cardiovasc Surg 2024; 168:796-808.e27. [PMID: 37149212 DOI: 10.1016/j.jtcvs.2023.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/27/2023] [Accepted: 04/30/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) is an established alternative to surgical aortic valve replacement (SAVR) for severe symptomatic aortic stenosis, although phase-specific survival and cause of death are implicated following these procedures. Herein, we conducted a phase-specific meta-analysis to compare outcomes after TAVR versus SAVR. METHODS A systematic search of databases was performed from inception through December 2022 to identify randomized controlled trials that compared outcomes of TAVR and SAVR. For each trial, the hazard ratio (HR) with 95% confidence interval (CI) of outcomes of interest was extracted for the following each specific phase: the very short-term (0-1 years after the procedure), short-term (1-2 years), and mid-term (2-5 years). Phase-specific HRs were separately pooled using the random-effects model. RESULTS Our analysis included 8 randomized controlled trials, which enrolled a total of 8885 patients with a mean age of 79 years. The survival after TAVR compared with SAVR was greater in the very short-term periods (HR, 0.85; 95% CI, 0.74-0.98; P = .02) but similar in the short-term periods. In contrast, lower survival was observed in the TAVR group compared with the SAVR group in the mid-term periods (HR, 1.15; 95% CI, 1.03-1.29; P = .02). Similar temporal trends favoring SAVR in the mid-term were present for cardiovascular mortality and rehospitalization rates. In contrast, the rates of aortic valve reinterventions and permanent pacemaker implantations were initially greater in the TAVR group, although SAVR's superiority eventually disappeared in the mid-term. CONCLUSIONS Our analysis demonstrated phase-specific outcomes following TAVR and SAVR.
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Affiliation(s)
- Yujiro Yokoyama
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pa.
| | - Tomonari Shimoda
- Department of Cardiovascular Surgery, University of Tsukuba Hospital, Ibaraki, Japan
| | - Brandon Sloan
- Department of Surgery, St Luke's University Health Network, Bethlehem, Pa
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Toshiki Kuno
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY.
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Hahn RT, Lindenfeld J, Lim SD, Mack MJ, Burkhoff D. Structural Cardiac Interventions in Patients With Heart Failure: JACC Scientific Statement. J Am Coll Cardiol 2024; 84:832-847. [PMID: 39168570 DOI: 10.1016/j.jacc.2024.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/13/2024] [Accepted: 05/28/2024] [Indexed: 08/23/2024]
Abstract
Pathologic left ventricular remodeling and valvular heart disease may contribute to the clinical presentation and outcomes of patients presenting with heart failure, and limit the effectiveness of guideline-directed medical therapy. Although surgical interventions including surgical ventricular restoration techniques and valve repair or replacement are effective therapies, there is growing evidence that transcatheter interventions may be options for patients with persistent symptoms of heart failure despite optimal medical therapy, where surgical options may be limited. This scientific statement will review the current available and investigational percutaneous strategies for the management of structural contributors to heart failure: dilated left ventricular cardiomyopathies and valvular heart disease.
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Affiliation(s)
- Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA.
| | - JoAnn Lindenfeld
- Advanced Heart Failure, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - Scott D Lim
- Department of Medicine, University of Virginia, Charlottesville, Virginia, USA; Division of Cardiology, St Paul's Hospital, Vancouver, British Columbia, Canada
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Jabri A, Ayyad M, Albandak M, Al-Abdouh A, Madanat L, Khalefa BB, Alhuneafat L, Ayyad A, Lemor A, Mhanna M, Al Jebaje Z, Fadel R, Gonzalez PE, O'Neill B, Bagur R, Hanson ID, Abbas AE, Frisoli T, Lee J, Wang DD, Aggarwal V, Alaswad K, O'Neill WW, Aronow HD, AlQarqaz M, Villablanca P. Outcomes following TAVR in patients with cardiogenic shock: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00622-5. [PMID: 39209579 DOI: 10.1016/j.carrev.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 07/25/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND While transcatheter aortic valve replacement (TAVR) has broadened treatment options for critically ill patients, outcomes among those with concomitant cardiogenic shock (CS) are not well-explored. METHODS We conducted a comprehensive search of major databases for studies comparing outcomes following TAVR in patients with and without CS since inception up to October 31, 2023. Our meta-analysis included five non-randomized observational. Dichotomous outcomes were assessed using the Mantel-Haenszel method (risk ratio, 95 % CI), and continuous outcomes were evaluated using mean difference and 95 % CI with the inverse variance method. Statistical heterogeneity was determined using the inconsistency test (I2). RESULTS Among 26,283 patients across five studies, 30-day mortality was higher in the CS group (7267 patients; 27.6 %) compared to those without CS (OR 3.41, 95 % CI [2.01, 5.76], p < 0.01), as well as 30-day major vascular complications (OR 1.72, 95 % CI [1.54, 1.92], p < 0.01). At 1-year follow-up, there was no statistically significant difference in mortality rates between the compared groups (OR 2.68, 95 % CI [0.53, 13.46], p = 0.12). No significant between-group differences were observed in the likelihood of 30-day aortic valve reintervention (OR 3.20, 95 % CI [0.63, 16.22], p = 0.09) or post-TAVR aortic insufficiency (OR 0.91, 95 % CI [0.33, 2.51], p = 0.73). Furthermore, 30-day stroke, pacemaker implantation, and in-hospital major bleeding were comparable between both cohorts. CONCLUSION Among patients undergoing TAVR, short-term mortality is higher but one-year outcomes are similar when comparing those with, to those without, CS. Future studies should examine whether TAVR outcomes are improved when the procedure is delayed to optimize CS and when delay is not possible, whether particular management strategies lead to more favorable periprocedural outcomes.
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Affiliation(s)
- Ahmad Jabri
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Mohammed Ayyad
- Department of Internal Medicine, Rutgers New Jersey Medical school, Newark, NJ, USA
| | - Maram Albandak
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Ahmad Al-Abdouh
- Division of Hospital Medicine, University of Kentucky, Lexington, KY, USA
| | - Luai Madanat
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | | | - Laith Alhuneafat
- Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA
| | - Asem Ayyad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Alejandro Lemor
- Division of Cardiovascular Disease, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohammed Mhanna
- Division of Cardiovascular Medicine, University of Iowa, IA, USA
| | - Zaid Al Jebaje
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Raef Fadel
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Pedro Engel Gonzalez
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Brian O'Neill
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, Canada Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ivan D Hanson
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Amr E Abbas
- Department of Cardiovascular Medicine, William Beaumont University Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Tiberio Frisoli
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - James Lee
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Dee Dee Wang
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Vikas Aggarwal
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - William W O'Neill
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Mohammad AlQarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Michigan State University, College of Human Medicine, Detroit, MI, USA.
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Fukuhara S, Kim KM, Yang B, Romano M, Ailawadi G, Patel HJ, Deeb GM. Reoperation following transcatheter aortic valve replacement: Insights from 10 years' experience. J Thorac Cardiovasc Surg 2024; 168:488-497.e3. [PMID: 37164056 DOI: 10.1016/j.jtcvs.2023.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Use of transcatheter aortic valve replacement (TAVR) has demonstrated dramatic growth in the past decade. This study aims to investigate implications of post-TAVR reoperation from our 10-year experience. METHODS Between 2011 and 2022, 66 post-TAVR patients underwent a reoperation, consisting of 42 (63.6%) patients with native TAVR and 24 (36.4%) patients with valve-in-valve TAVR (VIV-TAVR) after surgical aortic valve replacement. RESULTS The aggregate proportion of patients belonging to the low-/intermediate-risk group at the time of TAVR exceeded that of the high-/extreme-risk cohort in 2021. The native TAVR group received a larger TAVR valve, whereas more frequent low-risk status at the time of TAVR than the VIV-TAVR group. Concurrent procedures were highly common during reoperation and isolated surgical aortic valve replacement represented only 18.2% of the entire cohort. The native TAVR group demonstrated significantly higher TAVR explant difficulty index score (2.0 vs 1.0 points; P < .001) and operative mortality (14.2% vs 0%; P = .079) compared with the VIV-TAVR group. The 8-year cumulative incidence of reoperation was 1.9% and 14.1% (subdistribution hazard ratio, 8.0; 95% CI, 4.1-15.9; P < .001) in the native and VIV-TAVR group, respectively. Furthermore, cumulative incidence of valve reintervention, combining reoperations and redo TAVRs, was 3.3% and 19.0% (subdistribution hazard ratio, 6.2; 95% CI, 3.6-10.9; P < .001). CONCLUSIONS Low-/intermediate-risk patients are emerging as the predominant group necessitating reoperations. Native TAVR was associated with lower postimplant reintervention rates, albeit with higher reoperative technical difficulty and mortality. Conversely, VIV-TAVR was associated with higher reintervention, but demonstrated lower technical difficulty and mortality for reoperation.
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Affiliation(s)
- Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich.
| | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Matthew Romano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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10
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Di Pietro G, Improta R, De Filippo O, Bruno F, Birtolo LI, Tocci M, Fabris T, Saade W, Colantonio R, Celli P, Sardella G, Esposito G, Tarantini G, Mancone M, D'Ascenzo F. Transcatheter Aortic Valve Replacement in Low Surgical Risk Patients: An Updated Metanalysis of Extended Follow-Up Randomized Controlled Trials. Am J Cardiol 2024; 224:56-64. [PMID: 38729335 DOI: 10.1016/j.amjcard.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/03/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024]
Abstract
The long-term safety and effectiveness of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk has not been evaluated in a pooled analysis. An electronic database search was conducted for randomized controlled trials with a maximal 5 years clinical and echocardiographic follow-up including low surgical risk patients who underwent TAVR or SAVR. We calculated odds ratio (OR) and 95% confidence intervals (CIs) using a random-effects model. Subgroups analysis was performed for permanent pacemaker implantation and paravalvular leaks. Three randomized controlled trials were included with a total of 2,611 low surgical risk patients (Society of Thoracic Surgeons score <4%). Compared with SAVR, the TAVR group had similar rates of all-cause mortality (OR 0.94,95% CI 0.65 to 1.37, p = 0.75) and disabling stroke (OR 0.84, 95% CI 0.52 to 1.36, p = 0.48). No significant differences were registered in the TAVR group in terms of major cardiovascular events (OR 0.96, 95% CI 0.67 to 1.38, p = 0.83), myocardial infarction (OR 0.69, 95% CI 0.34 to 1.40, p = 0.31), valve thrombosis (OR 3.11, 95% CI 0.29 to 33.47, p = 0.35), endocarditis (OR 0.71,95% CI 0.35 to 1.48, p = 0.36), aortic valve reintervention (OR 0.93, 95% CI 0.52 to 1.66, p = 0.80), and rehospitalization (OR 0.80, 95% CI 0.52 to 1.02, p = 0.07) compared with SAVR. However, TAVR patients had a higher risk of paravalvular leaks (OR 8.21, 95% CI 4.18 to 16.14, p <0.00001), but lower rates of new-onset atrial fibrillation (OR 0.27,95% CI 0.17 to 0.30, p <0.0001). The rates of permanent pacemaker implantation were comparable from 1 year up to a maximum of 5 years (OR 1.32, 95% CI 0.88 to 1.97, p = 0.18). Lastly, TAVR had a greater effective orifice area (0.10 cm2/m2, 95% CI 0.05 to 0.15, p = 0.0001), but similar transvalvular mean gradients (0.60, 95% CI 3.94 to 2.73, p = 0.72). In conclusion, TAVR patients had similar long-term outcomes compared with SAVR, except for an elevated risk of paravalvular leaks in the TAVR group and increased rates of atrial fibrillation in the SAVR cohort.
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Affiliation(s)
- Gianluca Di Pietro
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Riccardo Improta
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy; Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Ovidio De Filippo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Marco Tocci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Tommaso Fabris
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Wael Saade
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Riccardo Colantonio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Paola Celli
- Department of General and Specialistic Surgery "Paride Stefanini", "Sapienza" University of Rome, Rome, Italy
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University of Rome, Italy.
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Molinette Hospital, Turin University, Italy
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11
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Hyung K An J, Faridmoayer E, Haefner L, Salami AC, Sharath SE, Kougias P. Trends and predictors of inflation-adjusted costs in transcatheter and surgical aortic valve replacement in a nationally representative sample. Surgery 2024; 176:289-294. [PMID: 38772777 DOI: 10.1016/j.surg.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement has become an accepted alternative to surgical aortic valve replacement. We examined the trends and predictors in inflation-adjusted costs of transcatheter aortic valve replacement and surgical aortic valve replacement. METHODS National Inpatient Sample identified patients who underwent aortic valve replacement for severe aortic stenosis by International Classification of Diseases, Ninth and Tenth Revisions, codes. Hospitalization costs were inflation-adjusted using the Federal Reserve's consumer price index to reflect current valuation. Outcomes of interest were unadjusted trend in annual cost for each procedure and predictors of in-patient cost. Generalized linear models with a log link function identified predictors of adjusted costs. Interaction terms determined where cost predictors were different by operation type. RESULTS Between 2011 and 2019, the mean annual inflation-adjusted cost of surgical aortic valve replacement increased from $62,853 to $63,743, in contrast to decreasing cost of transcatheter aortic valve replacement from $64,913 to $56,042 ($1,854 per year; P = .004). Significant independent predictors of patient-level cost included operation type (transcatheter aortic valve replacement associated with $9,625 increase; P < .001), incidence of in-hospital mortality ($28,836 increase; P < .001), elective status ($2,410 decrease; P < .001), Elixhauser Index ($995 increase; P < .001), and postoperative length of stay ($2,014 per day increase; P < .001). Compared to discharges with Medicare, discharges with private insurance and Medicaid paid $736 less (P = .004) and $1,863 less (P = .01), respectively. Increasing hospital volume was a significant predictor of decreasing patient level cost (P < .001). CONCLUSION Annual cost of transcatheter aortic valve replacement has decreased significantly and has been a more cost-effective modality compared to surgical aortic valve replacement since 2017. Predictors of patient-level costs allow for mindful preparation of healthcare systems for aortic valve replacement.
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Affiliation(s)
- Ju Hyung K An
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/kja485
| | - Erfan Faridmoayer
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/ErfanFarid
| | - Lindsay Haefner
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY
| | - Aitua C Salami
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN. https://twitter.com/ACSalami
| | - Sherene E Sharath
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY.
| | - Panos Kougias
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY. https://twitter.com/KougiasP
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12
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Ternacle J, Hecht S, Eltchaninoff H, Salaun E, Clavel MA, Côté N, Pibarot P. Durability of transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e845-e864. [PMID: 39007831 PMCID: PMC11228542 DOI: 10.4244/eij-d-23-01050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/22/2024] [Indexed: 07/16/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) is now utilised as a less invasive alternative to surgical aortic valve replacement (SAVR) across the whole spectrum of surgical risk. Long-term durability of the bioprosthetic valves has become a key goal of TAVI as this procedure is now considered for younger and lower-risk populations. The purpose of this article is to present a state-of-the-art overview on the definition, aetiology, risk factors, mechanisms, diagnosis, clinical impact, and management of bioprosthetic valve dysfunction (BVD) and failure (BVF) following TAVI with a comparative perspective versus SAVR. Structural valve deterioration (SVD) is the main factor limiting the durability of the bioprosthetic valves used for TAVI or SAVR, but non-structural BVD, such as prosthesis-patient mismatch and paravalvular regurgitation, as well as valve thrombosis or endocarditis may also lead to BVF. The incidence of BVF related to SVD or other causes is low (<5%) at midterm (5- to 8-year) follow-up and compares favourably with that of SAVR. The long-term follow-up data of randomised trials conducted with the first generations of transcatheter heart valves also suggest similar valve durability in TAVI versus SAVR at 10 years, but these trials suffer from major survivorship bias, and the long-term durability of TAVI will need to be confirmed by the analysis of the low-risk TAVI versus SAVR trials at 10 years.
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Affiliation(s)
- Julien Ternacle
- Unité Médico-Chirurgicale des Valvulopathies, Hôpital Haut-Leveque, CHU Bordeaux, Pessac, France
| | - Sébastien Hecht
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Hélène Eltchaninoff
- Department of Cardiology, University of Rouen Normandie, Inserm U1096, CHU Rouen, Rouen, France
| | - Erwan Salaun
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Marie-Annick Clavel
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Nancy Côté
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute - Laval University, Québec, Canada
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13
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Talanas G, Laconi A, Kereiakes DJ, Merella P, Reardon MJ, Spano A, Petretto G, Lauriola F, Casula M, Micheluzzi V, Isgender M, Chatzizisis Y, Farkouh ME, Lansky AJ, Piazza N, Portoghese M, Casu G, Navarese EP. Long-Term Outcomes of Transcatheter vs Surgical Aortic Valve Replacement: Meta-analysis of Randomized Trials. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2024; 3:102143. [PMID: 39131994 PMCID: PMC11307397 DOI: 10.1016/j.jscai.2024.102143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 08/13/2024]
Abstract
Background We aimed to perform a meta-analysis of randomized trials comparing long-term outcomes of patients undergoing transcatheter aortic valve replacement (TAVR) vs surgical aortic valve replacement (SAVR) for severe aortic stenosis. The short-term efficacy and safety of TAVR are proven, but long-term outcomes are unclear. Methods We included randomized controlled trials comparing TAVR vs SAVR at the longest available follow-up. The primary end point was death or disabling stroke. Secondary end points were all-cause mortality, cardiac mortality, stroke, pacemaker implantation, valve thrombosis, valve gradients, and moderate-to-severe paravalvular leaks. The study is registered with PROSPERO (CRD42023481856). Results Seven trials (N = 7785 patients) were included. Weighted mean trial follow-up was 5.76 ± 0.073 years. Overall, no significant difference in death or disabling stroke was observed with TAVR vs SAVR (HR, 1.02; 95% CI, 0.93-1.11; P = .70). Mortality risks were similar. TAVR resulted in higher pacemaker implantation and moderate-to-severe paravalvular leaks compared to SAVR. Results were consistent across different surgical risk profiles. As compared to SAVR, self-expanding TAVR had lower death or stroke risk (P interaction = .06), valve thrombosis (P interaction = .06), and valve gradients (P interaction < .01) but higher pacemaker implantation rates than balloon-expandable TAVR (P interaction < .01). Conclusions In severe aortic stenosis, the long-term mortality or disabling stroke risk of TAVR is similar to SAVR, but with higher risk of pacemaker implantation, especially with self-expanding valves. As compared with SAVR, the relative reduction in death or stroke risk and valve thrombosis was greater with self-expanding than with balloon-expandable valves.
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Affiliation(s)
- Giuseppe Talanas
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Angelo Laconi
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | | | - Pierluigi Merella
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Michael J. Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas
| | - Andrea Spano
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Gerardo Petretto
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Francesco Lauriola
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Marta Casula
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Valentina Micheluzzi
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Mehriban Isgender
- Republican Clinical Hospital, Department of Cardiology, Azerbaijan Medical University, Department of Family Medicine, Baku, Azerbaijan
| | - Yiannis Chatzizisis
- Center for Digital Cardiovascular Innovations, Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Alexandra J. Lansky
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nicolo Piazza
- McGill University Health Center, Montreal, Quebec, Canada
| | - Michele Portoghese
- Department of Cardiovascular Surgery, University of Sassari, Sassari, Italy
| | - Gavino Casu
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
- SIRIO MEDICINE Research Network, Sassari, Italy
| | - Eliano Pio Navarese
- Clinical Experimental Cardiology, Clinical and Interventional Cardiology, University of Sassari, Sassari, Italy
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14
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Amin S, Baron SJ, Galper BZ. Aortic valve replacement today: Outcomes, costs, and opportunities for improvement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:78-86. [PMID: 38388246 DOI: 10.1016/j.carrev.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) just two decades ago has transformed the treatment of severe symptomatic aortic stenosis. TAVR has not only extended the option of aortic valve replacement to patients deemed ineligible for surgery, it has also demonstrated similar or better short- and intermediate-term clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients at all levels of surgical risk. These benefits have been achieved with similar or lower costs compared with SAVR, at least in the first 1-2 years for intermediate- and low-risk patients. Longer-term data will further inform clinical and shared decision-making. SUMMARY FOR ANNOTATED TABLE OF CONTENTS: In just over two decades, transcatheter aortic valve replacement has emerged as a frontline approach for appropriately selected patients with severe aortic stenosis. A growing body of evidence documents similar or better clinical outcomes and cost-effectiveness for transcatheter compared with surgical aortic valve replacement. Whether the mode is transcatheter or surgical, aortic valve replacement remains underutilized in patients with clear indications for intervention.
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Affiliation(s)
- Sameer Amin
- L.A. Care Health Plan, 1055 W. 7th St, 10th Floor, Los Angeles, CA 90017, United States
| | - Suzanne J Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Outcomes Research, Baim Institute for Clinical Research, 930 W. Commonwealth Ave., Boston, MA 02215, United States
| | - Benjamin Z Galper
- Structural Heart Disease Program, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr., McLean, VA 22102, United States; Cardiac Catheterization Laboratory, Virginia Hospital Center, 1701 N. George Mason Dr., Arlington, VA 22205, United States.
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15
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Del Portillo JH, Kalavrouziotis D, Dumont E, Paradis JM, Poulin A, Beaupré F, Avvedimento M, Mas-Peiro S, Cepas-Guillén P, Mengi S, Mohammadi S, Rodés-Cabau J. Five-year outcomes of transcarotid transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00539-7. [PMID: 38936601 DOI: 10.1016/j.jtcvs.2024.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Transcarotid transcatheter aortic valve replacement (TC-TAVR) has emerged as an alternative access route for transcatheter aortic valve replacement (TAVR). However, scarce data exist on long-term outcomes following TC-TAVR. This study aimed to evaluate clinical outcomes at 5 years after TC-TAVR. METHODS A total of 110 consecutive patients who underwent TC-TAVR were included. Baseline, procedural, and follow-up data were collected prospectively in a dedicated database. The primary endpoint was the incidence of a composite outcome of all-cause mortality, stroke, and repeat hospitalization at 5-year follow-up. Echocardiography results, New York Heart Association (NYHA) class, and quality of life (QoL) as assessed with the EuroQol visual analog scale (EQ-VAS) were examined over the 5-year follow-up. RESULTS The median patient age was 77 years (interquartile range [IQR], 72-82.2 years), 42.3% were women, and the median Society of Thoracic Surgeons (STS) risk score was 5.02% (IQR, 3.4%-7.5%). The incidence of the composite primary endpoint was 54.5%. Death from any cause occurred in 45.6% of patients (11.9 per 100 patient-years); stroke in 8.2% (1.9 per 100 patient-years); disabling stroke in 2.7% (0.7 per 100 patient-years); and rehospitalization in 27.2%. The improvements in valve hemodynamics, NYHA class, and EQ-VAS following the procedure persisted at 5-year follow-up (P < .001). The incidence of bioprosthetic valve failure was 0.9%. CONCLUSIONS About half of the moderate-to high-risk patients undergoing TC-TAVR survived with no major cardiovascular events at the 5-year follow-up. The yearly incidence of stroke events was low, and early improvements in valve hemodynamics, functional status, and QoL persisted at 5 years. These results suggest the long-term safety and efficacy of TC-TAVR and would support this approach as an alternative to surgery in non-transfemoral candidates.
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Affiliation(s)
- Juan Hernando Del Portillo
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Eric Dumont
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jean-Michel Paradis
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Anthony Poulin
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Frederic Beaupré
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marisa Avvedimento
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Silvia Mas-Peiro
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Pedro Cepas-Guillén
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siddhartha Mengi
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Departments of Cardiology and Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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16
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Sazzad F, Ler AAL, Furqan MS, Tan LKZ, Leo HL, Kuntjoro I, Tay E, Kofidis T. Harnessing the power of artificial intelligence in predicting all-cause mortality in transcatheter aortic valve replacement: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1343210. [PMID: 38883982 PMCID: PMC11176615 DOI: 10.3389/fcvm.2024.1343210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Objectives In recent years, the use of artificial intelligence (AI) models to generate individualised risk assessments and predict patient outcomes post-Transcatheter Aortic Valve Implantation (TAVI) has been a topic of increasing relevance in literature. This study aims to evaluate the predictive accuracy of AI algorithms in forecasting post-TAVI mortality as compared to traditional risk scores. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Systematic Reviews (PRISMA) standard, a systematic review was carried out. We searched four databases in total-PubMed, Medline, Embase, and Cochrane-from 19 June 2023-24 June, 2023. Results From 2,239 identified records, 1,504 duplicates were removed, 735 manuscripts were screened, and 10 studies were included in our review. Our pooled analysis of 5 studies and 9,398 patients revealed a significantly higher mean area under curve (AUC) associated with AI mortality predictions than traditional score predictions (MD: -0.16, CI: -0.22 to -0.10, p < 0.00001). Subgroup analyses of 30-day mortality (MD: -0.08, CI: -0.13 to -0.03, p = 0.001) and 1-year mortality (MD: -0.18, CI: -0.27 to -0.10, p < 0.0001) also showed significantly higher mean AUC with AI predictions than traditional score predictions. Pooled mean AUC of all 10 studies and 22,933 patients was 0.79 [0.73, 0.85]. Conclusion AI models have a higher predictive accuracy as compared to traditional risk scores in predicting post-TAVI mortality. Overall, this review demonstrates the potential of AI in achieving personalised risk assessment in TAVI patients. Registration and protocol This systematic review and meta-analysis was registered under the International Prospective Register of Systematic Reviews (PROSPERO), under the registration name "All-Cause Mortality in Transcatheter Aortic Valve Replacement Assessed by Artificial Intelligence" and registration number CRD42023437705. A review protocol was not prepared. There were no amendments to the information provided at registration. Systematic Review Registration https://www.crd.york.ac.uk/, PROSPERO (CRD42023437705).
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Affiliation(s)
- Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ashlynn Ai Li Ler
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mohammad Shaheryar Furqan
- Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Linus Kai Zhe Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hwa Liang Leo
- Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre, Singapore, National University Hospital, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, Singapore, National University Hospital, Singapore, Singapore
- Asian Heart & Vascular Centre (AHVC), Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Theo Kofidis
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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17
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Zou Q, Wei Z, Sun S. Complications in transcatheter aortic valve replacement: A comprehensive analysis and management strategies. Curr Probl Cardiol 2024; 49:102478. [PMID: 38437930 DOI: 10.1016/j.cpcardiol.2024.102478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 03/06/2024]
Abstract
Transcatheter Aortic Valve Replacement (TAVR) marks a significant advancement in treating aortic stenosis (AS), especially for patients with high surgical risks. This concise review outlines TAVR's development, its broader application to include lower-risk patients, and innovations in the device and procedural technology. Clinical trials, notably the PARTNER series, affirm TAVR's efficacy, showing it matches or surpasses surgical aortic valve replacement (SAVR) in mortality reduction, hemodynamic benefits, and symptom alleviation, including heart failure. However, TAVR entails complications such as paravalvular leakage (PVL), conduction disorders, and increased cerebrovascular event risks. We evaluate these issues, their prevalence, causative factors, and clinical consequences, emphasizing improvements in valve design and technique that have significantly lowered PVL rates. The role of aortic valve anatomy and calcification in PVL and conduction issues is analyzed, underlining the necessity for meticulous patient selection and procedural planning. Further, the review delves into cerebrovascular event risks, their origins, and preventative strategies, including cerebral protection devices and the judicious use of anticoagulant and antiplatelet therapies. TAVR presents a less invasive, promising alternative to SAVR, but requires careful complication management to optimize patient results. Ongoing innovation and research are vital for advancing TAVR's techniques, improving valve designs, and extending its reach, thereby enhancing AS patients' quality of life.
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Affiliation(s)
- Qi Zou
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhiliang Wei
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China
| | - Shougang Sun
- Department of Cardiology, Lanzhou University Second Hospital, Lanzhou, China.
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18
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Grubb KJ, Lisko JC, O'Hair D, Merhi W, Forrest JK, Mahoney P, Van Mieghem NM, Windecker S, Yakubov SJ, Williams MR, Chetcuti SJ, Deeb GM, Kleiman NS, Althouse AD, Reardon MJ. Reinterventions After CoreValve/Evolut Transcatheter or Surgical Aortic Valve Replacement for Treatment of Severe Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:1007-1016. [PMID: 38573257 DOI: 10.1016/j.jcin.2024.01.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 12/26/2023] [Accepted: 01/20/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Data on valve reintervention after transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) are limited. OBJECTIVES The authors compared the 5-year incidence of valve reintervention after self-expanding CoreValve/Evolut TAVR vs SAVR. METHODS Pooled data from CoreValve and Evolut R/PRO (Medtronic) randomized trials and single-arm studies encompassed 5,925 TAVR (4,478 CoreValve and 1,447 Evolut R/PRO) and 1,832 SAVR patients. Reinterventions were categorized by indication, timing, and treatment. The cumulative incidence of reintervention was compared between TAVR vs SAVR, Evolut vs CoreValve, and Evolut vs SAVR. RESULTS There were 99 reinterventions (80 TAVR and 19 SAVR). The cumulative incidence of reintervention through 5 years was higher with TAVR vs SAVR (2.2% vs 1.5%; P = 0.017), with differences observed early (≤1 year; adjusted subdistribution HR: 3.50; 95% CI: 1.53-8.02) but not from >1 to 5 years (adjusted subdistribution HR: 1.05; 95% CI: 0.48-2.28). The most common reason for reintervention was paravalvular regurgitation after TAVR and endocarditis after SAVR. Evolut had a significantly lower incidence of reintervention than CoreValve (0.9% vs 1.6%; P = 0.006) at 5 years with differences observed early (adjusted subdistribution HR: 0.30; 95% CI: 0.12-0.73) but not from >1 to 5 years (adjusted subdistribution HR: 0.61; 95% CI: 0.21-1.74). The 5-year incidence of reintervention was similar for Evolut vs SAVR (0.9% vs 1.5%; P = 0.41). CONCLUSIONS A low incidence of reintervention was observed for CoreValve/Evolut R/PRO and SAVR through 5 years. Reintervention occurred most often at ≤1 year for TAVR and >1 year for SAVR. Most early reinterventions were with the first-generation CoreValve and managed percutaneously. Reinterventions were more common following CoreValve TAVR compared with Evolut TAVR or SAVR.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia, USA.
| | - John C Lisko
- Division of Cardiology, Emory University, Atlanta, Georgia, USA
| | - Daniel O'Hair
- Cardiovascular Service Line, Boulder Community Health, Boulder, Colorado, USA
| | - William Merhi
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA; Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Paul Mahoney
- University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pennsylvania, USA
| | | | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Stanley J Chetcuti
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- University of Michigan Health Systems-University Hospital, Ann Arbor, Michigan, USA
| | - Neal S Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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19
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Kleiman NS, Van Mieghem NM, Reardon MJ, Gada H, Mumtaz M, Olsen PS, Heiser J, Merhi W, Chetcuti S, Deeb GM, Chawla A, Kiaii B, Teefy P, Chu MWA, Yakubov SJ, Windecker S, Althouse AD, Baron SJ. Quality of Life 5 Years Following Transfemoral TAVR or SAVR in Intermediate Risk Patients. JACC Cardiovasc Interv 2024; 17:979-988. [PMID: 38658126 DOI: 10.1016/j.jcin.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/12/2024] [Accepted: 02/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Symptomatic patients with severe aortic stenosis (AS) at high risk for surgical aortic valve replacement (SAVR) sustain comparable improvements in health status over 5 years after transcatheter aortic valve replacement (TAVR) or SAVR. Whether a similar long-term benefit is observed among intermediate-risk AS patients is unknown. OBJECTIVES The purpose of this study was to assess health status outcomes through 5 years in intermediate risk patients treated with a self-expanding TAVR prosthesis or SAVR using data from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. METHODS Intermediate-risk patients randomized to transfemoral TAVR or SAVR in the SURTAVI trial had disease-specific health status assessed at baseline, 30 days, and annually to 5 years using the Kansas City Cardiomyopathy Questionnaire (KCCQ). Health status was compared between groups using fixed effects repeated measures modelling. RESULTS Of the 1,584 patients (TAVR, n = 805; SAVR, n = 779) included in the analysis, health status improved more rapidly after TAVR compared with SAVR. However, by 1 year, both groups experienced large health status benefits (mean change in KCCQ-Overall Summary Score (KCCQ-OS) from baseline: TAVR: 20.5 ± 22.4; SAVR: 20.5 ± 22.2). This benefit was sustained, albeit modestly attenuated, at 5 years (mean change in KCCQ-OS from baseline: TAVR: 15.4 ± 25.1; SAVR: 14.3 ± 24.2). There were no significant differences in health status between the cohorts at 1 year or beyond. Similar findings were observed in the KCCQ subscales, although a substantial attenuation of benefit was noted in the physical limitation subscale over time in both groups. CONCLUSIONS In intermediate-risk AS patients, both transfemoral TAVR and SAVR resulted in comparable and durable health status benefits to 5 years. Further research is necessary to elucidate the mechanisms for the small decline in health status noted at 5 years compared with 1 year in both groups. (Safety and Efficacy Study of the Medtronic CoreValve® System in the Treatment of Severe, Symptomatic Aortic Stenosis in Intermediate Risk Subjects Who Need Aortic Valve Replacement [SURTAVI]; NCT01586910).
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Affiliation(s)
- Neal S Kleiman
- Department of Interventional Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | | | - Michael J Reardon
- Department of Cardiothoracic Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Hemal Gada
- Department of Interventional Cardiology, University of Pittsburgh Medical Center Pinnacle, Wormleysburg, Pennsylvania, USA
| | - Mubashir Mumtaz
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center Pinnacle Health, Harrisburg, Pennsylvania, USA
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - John Heiser
- Department of Interventional Cardiology, Corewell Health, Grand Rapids, Michigan, USA
| | - William Merhi
- Department of Cardiothoracic Surgery, Corewell Health, Grand Rapids, Michigan, USA
| | - Stanley Chetcuti
- Interventional Cardiology, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Atul Chawla
- Department of Cardiology, Iowa Heart Center, Des Moines, Iowa, USA
| | - Bob Kiaii
- Division of Cardiac Surgery, University of California-Davis Health, Sacramento, California, USA
| | - Patrick Teefy
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Divisions of Cardiology and Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Steven J Yakubov
- Interventional Cardiology, OhioHealth Riverside Methodist Hospital, Columbus, Ohio, USA
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Suzanne J Baron
- Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA
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20
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Bain ER, George B, Jafri SH, Rao RA, Sinha AK, Guglin ME. Outcomes in patients with aortic stenosis and severely reduced ejection fraction following surgical aortic valve replacement and transcatheter aortic valve replacement. J Cardiothorac Surg 2024; 19:258. [PMID: 38643131 PMCID: PMC11031863 DOI: 10.1186/s13019-024-02724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/29/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction demonstrate improvement in left ventricular injection fraction (LVEF) after aortic valve replacement (AVR). The timing and magnitude of recovery in patients with very low LVEF (≤ 25%) in surgical or transcatheter AVR is not well studied. OBJECTIVE Determine clinical outcomes following transcatheter aortic valve replacement (TAVR) and surgical aortic valve repair (SAVR) in the subset of patients with severely reduced EF ≤ 25%. METHODS Single-center, retrospective study with primary endpoint of LVEF 1-week following either procedure. Secondary outcomes included 30-day mortality and delayed postprocedural LVEF. T-test was used to compare variables and linear regression was used to adjust differences among baseline variables. RESULTS 83 patients were enrolled (TAVR = 56 and SAVR = 27). TAVR patients were older at the time of procedure (TAVR 77.29 ± 8.69 vs. SAVR 65.41 ± 10.05, p < 0.001). One week post procedure, all patients had improved LVEF after both procedures (p < 0.001). There was no significant difference in LVEF between either group (TAVR 33.5 ± 11.77 vs. SAVR 35.3 ± 13.57, p = 0.60). Average LVEF continued to rise and increased by 101% at final follow-up (41.26 ± 13.70). 30-day mortality rates in SAVR and TAVR were similar (7.4% vs. 7.1%, p = 0.91). CONCLUSION Patients with severe AS and LVEF ≤ 25% have a significant recovery in post-procedural EF following AVR regardless of method. LVEF doubled at two years post-procedure. There was no significant difference in 30-day mortality or mean EF recovery between TAVR and SAVR. TRIAL REGISTRATION Indiana University institutional review board granted approval for above study numbered 15,322.
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Affiliation(s)
- Eric R Bain
- Department of Internal Medicine, Indiana University School of Medicine, 635 Barnhill Drive Van Nuys Medical Science Building 116, Indianapolis, IN, 46202, USA.
| | - Bistees George
- Department of Internal Medicine, Indiana University School of Medicine, 635 Barnhill Drive Van Nuys Medical Science Building 116, Indianapolis, IN, 46202, USA
| | - Syed H Jafri
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Roopa A Rao
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Anjan K Sinha
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Maya E Guglin
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
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21
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Kim M, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim HJ, Lee J, Park J, Kim H, Cho S, Choi Y, Park SJ, Park DW. Sex-Specific Disparities in Clinical Outcomes After Transcatheter Aortic Valve Replacement Among Different Racial Populations. JACC. ASIA 2024; 4:292-302. [PMID: 38660112 PMCID: PMC11035955 DOI: 10.1016/j.jacasi.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Abstract
Background Sex-related disparities in clinical outcomes following transcatheter aortic valve replacement (TAVR) and the impact of sex on clinical outcomes after TAVR among different racial groups are undetermined. Objectives This study assessed whether sex-specific differences in baseline clinical and anatomical characteristics affect clinical outcomes after TAVR and investigated the impact of sex on clinical outcomes among different racial groups. Methods The TP-TAVR (Trans-Pacific TAVR) registry is a multinational cohort study of patients with severe aortic stenosis who underwent TAVR at 2 major centers in the United States and 1 major center in South Korea. The primary outcome was a composite of death from any cause, stroke, or rehospitalization after 1 year. Results The incidence of the primary composite outcome was not significantly different between sexes (27.9% in men vs 28% in women; adjusted HR: 0.97; 95% CI: 0.79-1.20). This pattern was consistent in Asian (23.5% vs 23.3%; adjusted HR: 0.99; 95% CI: 0.69-1.41) and non-Asian (30.8% vs 31.6%; adjusted HR: 0.95; 95% CI: 0.72-1.24) cohorts, without a significant interaction between sex and racial group (P for interaction = 0.74). The adjusted risk for all-cause mortality was similar between sexes, regardless of racial group. However, the adjusted risk of stroke was significantly lower in male patients than in female patients, which was more prominent in the non-Asian cohort. Conclusions Despite significantly different baseline and procedural characteristics, there were no sex-specific differences in the adjusted 1-year rates of primary composite outcomes and all-cause mortality, regardless of different racial groups. (Transpacific TAVR registry [TP-TAVR]; NCT03826264).
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Affiliation(s)
- Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Suji Cho
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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22
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Thyregod HGH, Jørgensen TH, Ihlemann N, Steinbrüchel DA, Nissen H, Kjeldsen BJ, Petursson P, De Backer O, Olsen PS, Søndergaard L. Transcatheter or surgical aortic valve implantation: 10-year outcomes of the NOTION trial. Eur Heart J 2024; 45:1116-1124. [PMID: 38321820 PMCID: PMC10984572 DOI: 10.1093/eurheartj/ehae043] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/26/2023] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND AND AIMS Transcatheter aortic valve implantation (TAVI) has become a viable treatment option for patients with severe aortic valve stenosis across a broad range of surgical risk. The Nordic Aortic Valve Intervention (NOTION) trial was the first to randomize patients at lower surgical risk to TAVI or surgical aortic valve replacement (SAVR). The aim of the present study was to report clinical and bioprosthesis outcomes after 10 years. METHODS The NOTION trial randomized 280 patients to TAVI with the self-expanding CoreValve (Medtronic Inc.) bioprosthesis (n = 145) or SAVR with a bioprosthesis (n = 135). The primary composite outcome was the risk of all-cause mortality, stroke, or myocardial infarction. Bioprosthetic valve dysfunction (BVD) was classified as structural valve deterioration (SVD), non-structural valve dysfunction (NSVD), clinical valve thrombosis, or endocarditis according to Valve Academic Research Consortium-3 criteria. Severe SVD was defined as (i) a transprosthetic gradient of 30 mmHg or more and an increase in transprosthetic gradient of 20 mmHg or more or (ii) severe new intraprosthetic regurgitation. Bioprosthetic valve failure (BVF) was defined as the composite rate of death from a valve-related cause or an unexplained death following the diagnosis of BVD, aortic valve re-intervention, or severe SVD. RESULTS Baseline characteristics were similar between TAVI and SAVR: age 79.2 ± 4.9 years and 79.0 ± 4.7 years (P = .7), male 52.6% and 53.8% (P = .8), and Society of Thoracic Surgeons score < 4% of 83.4% and 80.0% (P = .5), respectively. After 10 years, the risk of the composite outcome all-cause mortality, stroke, or myocardial infarction was 65.5% after TAVI and 65.5% after SAVR [hazard ratio (HR) 1.0; 95% confidence interval (CI) 0.7-1.3; P = .9], with no difference for each individual outcome. Severe SVD had occurred in 1.5% and 10.0% (HR 0.2; 95% CI 0.04-0.7; P = .02) after TAVI and SAVR, respectively. The cumulative incidence for severe NSVD was 20.5% and 43.0% (P < .001) and for endocarditis 7.2% and 7.4% (P = 1.0) after TAVI and SAVR, respectively. No patients had clinical valve thrombosis. Bioprosthetic valve failure occurred in 9.7% of TAVI and 13.8% of SAVR patients (HR 0.7; 95% CI 0.4-1.5; P = .4). CONCLUSIONS In patients with severe AS and lower surgical risk randomized to TAVI or SAVR, the risk of major clinical outcomes was not different 10 years after treatment. The risk of severe bioprosthesis SVD was lower after TAVR compared with SAVR, while the risk of BVF was similar.
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Affiliation(s)
- Hans Gustav Hørsted Thyregod
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Troels Højsgaard Jørgensen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Nikolaj Ihlemann
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark
| | - Daniel Andreas Steinbrüchel
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Bo Juel Kjeldsen
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark
| | - Petur Petursson
- Department of Cardiology, Sahlgrenska University Hospital, Blå Stråket 5, 413 45 Gothenburg, Sweden
| | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Skov Olsen
- Department of Cardiothoracic Surgery, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark
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23
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Ikenaga H, Takahashi S, Nakano Y. Contemporary Survival Trends After Transcatheter Aortic Valve Implantation. Circ J 2024; 88:472-474. [PMID: 38092411 DOI: 10.1253/circj.cj-23-0866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Shinya Takahashi
- Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences
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24
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Groginski T, Mansour A, Kamal D, Saad M. Transcatheter Aortic Valve Replacement for Failed Surgical or Transcatheter Bioprosthetic Valves: A Comprehensive Review. J Clin Med 2024; 13:1297. [PMID: 38592142 PMCID: PMC10932095 DOI: 10.3390/jcm13051297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/12/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has proven to be a safe, effective, and less invasive approach to aortic valve replacement in patients with aortic stenosis. In patients who underwent prior aortic valve replacement, transcatheter and surgical bioprosthetic valve dysfunction may occur as a result of structural deterioration or nonstructural causes such as prosthesis-patient mismatch (PPM) and paravalvular regurgitation. Valve-in-Valve (ViV) TAVR is a procedure that is being increasingly utilized for the replacement of failed transcatheter or surgical bioprosthetic aortic valves. Data regarding long-term outcomes are limited due to the recency of the procedure's approval, but available data regarding the short- and long-term outcomes of ViV TAVR are promising. Studies have shown a reduction in perioperative and 30-day mortality with ViV TAVR procedures compared to redo surgical repair of failed bioprosthetic aortic valves, but 1-year and 5-year mortality rates are more controversial and lack sufficient data. Despite the reduction in 30-day mortality, PPM and rates of coronary obstruction are higher in ViV TAVR as compared to both redo surgical valve repair and native TAVR procedures. New transcatheter heart valve designs and new procedural techniques have been developed to reduce the risk of PPM and coronary obstruction. Newer generation valves, new procedural techniques, and increased operator experience with ViV TAVR may improve patient outcomes; however, further studies are needed to better understand the safety, efficacy, and durability of ViV TAVR.
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Affiliation(s)
- Taylor Groginski
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA;
| | - Amr Mansour
- Department of Cardiology, Ain Shams University, Cairo 11566, Egypt; (A.M.); (D.K.)
| | - Diaa Kamal
- Department of Cardiology, Ain Shams University, Cairo 11566, Egypt; (A.M.); (D.K.)
| | - Marwan Saad
- Department of Medicine, Division of Cardiology, The Warren Alpert Medical School of Brown University, Providence, RI 02912, USA
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25
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Oikonomou G, Apostolos A, Drakopoulou M, Simopoulou C, Karmpalioti M, Toskas P, Stathogiannis K, Xanthopoulou M, Ktenopoulos N, Latsios G, Synetos A, Tsioufis C, Toutouzas K. Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:1200. [PMID: 38592019 PMCID: PMC10932005 DOI: 10.3390/jcm13051200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow-low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow-low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow-high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow-high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918-0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645-5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106-1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” General Hospital of Athens, 11527 Athens, Greece; (G.O.); (A.A.); (M.D.); (C.S.); (M.K.); (P.T.); (K.S.); (M.X.); (N.K.); (G.L.); (A.S.); (C.T.)
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Hayek A, Prieur C, Dürrleman N, Chatelain Q, Ibrahim R, Asgar A, Modine T, Ben Ali W. Clinical considerations and challenges in TAV-in-TAV procedures. Front Cardiovasc Med 2024; 11:1334871. [PMID: 38440208 PMCID: PMC10910030 DOI: 10.3389/fcvm.2024.1334871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/24/2024] [Indexed: 03/06/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a viable treatment for aortic valve disease, including low-risk patients. However, as TAVR usage increases, concerns about long-term durability and the potential for addition interventions have arisen. Transcatheter aortic valve (TAV)-in-TAV procedures have shown promise in selected patients in numerous registries, offering a less morbid alternative to TAVR explantation. In this review, the authors aimed to comprehensively review the experience surrounding TAV-in-TAV, summarize available data, discuss pre-procedural planning, highlight associated challenges, emphasize the importance of coronary obstruction assessment and provide insights into the future of this technique.
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Affiliation(s)
- Ahmad Hayek
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
- Department of Interventional Cardiology, Hospices Civils de Lyon, Lyon, France
| | - Cyril Prieur
- Department of Interventional Cardiology, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Dürrleman
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Quentin Chatelain
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Reda Ibrahim
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Anita Asgar
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Thomas Modine
- Service Médico-Chirurgical: Valvulopathies-Chirurgie Cardiaque-Cardiologie Interventionelle Structurelle, Hôpital Cardiologique de Haut Lévèque, CHU Bordeaux, Bordeaux, France
| | - Walid Ben Ali
- Structural Heart Intervention Program, Montreal Heart Institute, Montreal, QC, Canada
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Malaisrie SC, Mumtaz MA, Barnhart GR, Chitwood R, Ryan WH, Accola KD, Patel HJ, Woo YJ, Dewey TM, Koulogiannis K, Dorsey MP, Grossi EA. Midterm outcomes of aortic valve replacement using a rapid-deployment valve for aortic stenosis: TRANSFORM trial. JTCVS OPEN 2024; 17:55-63. [PMID: 38420551 PMCID: PMC10897657 DOI: 10.1016/j.xjon.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/12/2023] [Accepted: 10/26/2023] [Indexed: 03/02/2024]
Abstract
Background The use of rapid-deployment valves (RDVs) has been shown to reduce the operative time for surgical aortic valve replacement (AVR). Long-term core laboratory-adjudicated data are scarce, however. Here we report final 7-year data on RDV use. Methods TRANSFORM was a prospective, nonrandomized, multicenter, single-arm trial implanting a stented bovine pericardial valve with an incorporated balloon-expandable sealing frame. A prior published 1-year analysis included 839 patients from 29 centers. An additional 46 patients were enrolled and implanted, for a total of 885 patients. Annual clinical and core laboratory-adjudicated echocardiographic outcomes were collected through 8 years. Primary endpoints were structural valve deterioration (SVD), all-cause reintervention, all-cause valve explantation, and all-cause mortality. Secondary endpoints included hemodynamic performance assessed by echocardiography. The mean duration of follow-up was 5.0 ± 2.0 years. Results The mean patient age was 73.3 ± 8.2 years. Isolated AVR was performed in 62.1% of the patients, and AVR with concomitant procedures was performed in 37.9%. Freedom from all-cause mortality at 7 years was 76.0% for isolated AVR and 68.2% for concomitant AVR. Freedom from SVD, all-cause reintervention, and valve explantation at 7 years was 97.5%, 95.7%, and 97.8%, respectively. The mean gradient and effective orifice area at 7 years were 11.1 ± 5.3 mm Hg and 1.6 ± 0.3 cm2, respectively. Paravalvular leak at 7 years was none/trace in 88.6% and mild in 11.4%. In patients undergoing isolated AVR, the cumulative probability of pacemaker implantation was 13.9% at 30 days, 15.5% at 1 year, and 21.8% at 7 years. Conclusions AVR for aortic stenosis using an RDV is associated with low rates of late adverse events. This surgical pericardial tissue platform provides excellent and stable hemodynamic performance through 7 years.
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Affiliation(s)
| | - Mubashir A Mumtaz
- Department of Cardiovascular and Thoracic Surgery, University of Pittsburgh Medical Center Harrisburg, Harrisburg, Pa
| | - Glenn R Barnhart
- Structural Heart Program, Swedish Heart and Vascular Institute, Seattle, Wash
| | - Randolph Chitwood
- Department of Cardiovascular Sciences, East Carolina University, Greenville, NC
| | - William H Ryan
- Cardiac Surgery Specialists, Baylor Plano Heart Hospital, Plano, Tex
| | - Kevin D Accola
- Florida Hospital Cardiovascular Institute, Florida Hospital Orlando, Orlando, Fla
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, Calif
| | | | | | - Michael P Dorsey
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY
| | - Eugene A Grossi
- Department of Cardiothoracic Surgery, New York University Langone Medical Center, New York, NY
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Høydahl MP, Busund R, Rösner A, Kjønås D. Transcatheter aortic valve implantation (from inception to standard treatment): a single-center observational study. Front Cardiovasc Med 2024; 11:1298346. [PMID: 38287983 PMCID: PMC10822919 DOI: 10.3389/fcvm.2024.1298346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
Background Treatment of severe aortic stenosis with transcatheter aortic valve implantation (TAVI) was introduced in 2002. Since then, TAVI has become the primary treatment approach worldwide for advanced-age patients and younger patients with severe comorbidities. We aimed to evaluate the changes in patient demographics, complications, and mortality rates within 13 years. Methods This retrospective observational study included 867 patients who underwent TAVI at the University Hospital of North Norway in Tromsø from 2008 to 2021. The 13-year period was divided into period 1 (2008-2012), period 2 (2013-2017), and period 3 (2018-2021). The primary objective was to evaluate the changes in periprocedural (30 days), early (30-365 days), and late mortality rates (>365 days) between the periods. The secondary objective was to evaluate late mortality rates by sex and age groups: <70 years, 70-79 years, 80-89 years, and ≥90 years. Results The periprocedural mortality rates for periods 1, 2, and 3 were 10.3%, 2.9%, and 1.2%, respectively (P < 0.001). The early mortality rates were 5.6%, 5.8%, and 6.5%, respectively. No significant differences were observed in late mortality by sex or age group (<70, 70-79, and 80-89 years) with a median survival of 5.3-5.6 years. The median survival in patients aged ≥90 years was 4.0 years (P = 0.018). Conclusion Our findings indicate that most patients are octogenarians, and the burden of their comorbidities should be highly considered compared to their age when evaluating the procedural outcomes. As the incidence of most complications related to TAVI has decreased, the rates of permanent pacemaker implantation remain high. Important advancements in diagnostics, valve technology, and procedural techniques have improved the periprocedural mortality rates; however, early mortality remains unchanged and poses a clinical challenge that needs to be addressed in the future.
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Affiliation(s)
- Martin Petter Høydahl
- Clinical Cardiovascular Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Rolf Busund
- Clinical Cardiovascular Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Cardiothoracic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - Assami Rösner
- Clinical Cardiovascular Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Didrik Kjønås
- Clinical Cardiovascular Research Group, Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
- Department of Gastrointestinal Surgery, University Hospital of North Norway, Tromsø, Norway
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Šolc AJ, Línková H, Toušek P. Transcatheter aortic valve durability, predictors of bioprosthetic valve dysfunction, longer-term outcomes - a review. Expert Rev Med Devices 2024; 21:15-26. [PMID: 38032186 DOI: 10.1080/17434440.2023.2288275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is one of the most significant inventions in cardiology, as it provides a viable minimally invasive treatment option for patients with aortic stenosis, the most common valvular disease in the developed world and one with a poor prognosis when left untreated. Using data available to date, this review aims to discuss and identify possible predictors of TAVI valve durability - an essential requirement for the device's wide-spread use, especially in younger patients. AREAS COVERED This article explores the main causes of bioprosthetic valve dysfunction (BVD) based on pathophysiology and available data, and reviews possible predictors of BVD including prosthesis-related, procedure-related, and patient-related factors. An emphasis is made on affectable predictors, which could potentially be targeted with prevention management and improve valve durability. A literature search of online medical databases was conducted using relevant key words and dates; significant clinical trials were identified. A brief overview of important randomized controlled trials with mid to long-term follow-up is included in this article. EXPERT OPINION Identifying modifiable predictors of valve dysfunction presents an opportunity to enhance and predict valve durability - a necessity as patients with longer life-expectancies are being considered for the procedure.
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Affiliation(s)
- Abigail Johanna Šolc
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Hana Línková
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic
| | - Petr Toušek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Královské Vinohrady, Charles University, Prague, Czech Republic
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Baron SJ, Ryan MP, Chikermane SG, Thompson C, Clancy S, Gunnarsson CL. Long-term risk of reintervention after transcatheter aortic valve replacement. Am Heart J 2024; 267:44-51. [PMID: 37871783 DOI: 10.1016/j.ahj.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has surpassed surgical aortic valve replacement (SAVR) as the predominant mode of valve replacement for the treatment of severe aortic stenosis (AS). However, the long-term need for valvular reintervention after TAVR remains unknown. METHODS Using data from the Medicare Fee for Service 100% dataset, all patients receiving TAVR between July 2011 and December 2020 were identified. Patients were categorized as receiving a valve reintervention (either surgical or transcatheter) or not using the appropriate International Classification of Diseases 10th Revision Procedure Coding System (ICD-10-PCS). A competing risk regression model was used to estimate the cumulative probability of valve reintervention. RESULTS Of 230,644 TAVR patients were identified, of whom 1,880 received a reintervention. Patients receiving a reintervention were younger and more likely to be male. At 10 years, the crude rate of reintervention was 0.59% within a surviving cohort of 341 patients. After adjusting for the competing risk of death and other covariates, the adjusted cumulative incidence of reintervention at 10 years after TAVR was 1.63%. When the rate of reinterventions was compared between early (2011-2016) and later (2017-2020) time periods, the risk-adjusted rate of reintervention at 4 years had decreased over time (0.85% vs 0.51%). CONCLUSION The 10-year risk of valve reintervention after TAVR is low and appears to be decreasing over time. Further research is necessary to determine the driving factors contributing to valve reintervention in the current era.
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Affiliation(s)
- Suzanne J Baron
- Massachusetts General Hospital, Boston, MA; Baim Institute for Clinical Research, Boston, MA.
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Zou J, Yuan J, Liu J, Geng Q. Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses. Front Cardiovasc Med 2023; 10:1164104. [PMID: 38152609 PMCID: PMC10751363 DOI: 10.3389/fcvm.2023.1164104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 11/28/2023] [Indexed: 12/29/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.
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Affiliation(s)
- Jieru Zou
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
| | - Jie Yuan
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Jingjin Liu
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
| | - Qingshan Geng
- The Second Clinical Medical College, Jinan University, Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
- Department of Cardiology, Shenzhen Cardiovascular Minimally Invasive Medical Engineering Technology Research and Development Center, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
- Department of Geriatrics, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, China
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Mack MJ, Leon MB, Thourani VH, Pibarot P, Hahn RT, Genereux P, Kodali SK, Kapadia SR, Cohen DJ, Pocock SJ, Lu M, White R, Szerlip M, Ternacle J, Malaisrie SC, Herrmann HC, Szeto WY, Russo MJ, Babaliaros V, Smith CR, Blanke P, Webb JG, Makkar R. Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years. N Engl J Med 2023; 389:1949-1960. [PMID: 37874020 DOI: 10.1056/nejmoa2307447] [Citation(s) in RCA: 112] [Impact Index Per Article: 112.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
BACKGROUND A previous analysis in this trial showed that among patients with severe, symptomatic aortic stenosis who were at low surgical risk, the rate of the composite end point of death, stroke, or rehospitalization at 1 year was significantly lower with transcatheter aortic-valve replacement (TAVR) than with surgical aortic-valve replacement. Longer-term outcomes are unknown. METHODS We randomly assigned patients with severe, symptomatic aortic stenosis and low surgical risk to undergo either TAVR or surgery. The first primary end point was a composite of death, stroke, or rehospitalization related to the valve, the procedure, or heart failure. The second primary end point was a hierarchical composite that included death, disabling stroke, nondisabling stroke, and the number of rehospitalization days, analyzed with the use of a win ratio analysis. Clinical, echocardiographic, and health-status outcomes were assessed through 5 years. RESULTS A total of 1000 patients underwent randomization: 503 patients were assigned to undergo TAVR, and 497 to undergo surgery. A component of the first primary end point occurred in 111 of 496 patients in the TAVR group and in 117 of 454 patients in the surgery group (Kaplan-Meier estimates, 22.8% in the TAVR group and 27.2% in the surgery group; difference, -4.3 percentage points; 95% confidence interval [CI], -9.9 to 1.3; P = 0.07). The win ratio for the second primary end point was 1.17 (95% CI, 0.90 to 1.51; P = 0.25). The Kaplan-Meier estimates for the components of the first primary end point were as follows: death, 10.0% in the TAVR group and 8.2% in the surgery group; stroke, 5.8% and 6.4%, respectively; and rehospitalization, 13.7% and 17.4%. The hemodynamic performance of the valve, assessed according to the mean (±SD) valve gradient, was 12.8±6.5 mm Hg in the TAVR group and 11.7±5.6 mm Hg in the surgery group. Bioprosthetic-valve failure occurred in 3.3% of the patients in the TAVR group and in 3.8% of those in the surgery group. CONCLUSIONS Among low-risk patients with severe, symptomatic aortic stenosis who underwent TAVR or surgery, there was no significant between-group difference in the two primary composite outcomes. (Funded by Edwards Lifesciences; PARTNER 3 ClinicalTrials.gov number, NCT02675114.).
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Affiliation(s)
- Michael J Mack
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Martin B Leon
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Vinod H Thourani
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philippe Pibarot
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Rebecca T Hahn
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philippe Genereux
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Susheel K Kodali
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Samir R Kapadia
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - David J Cohen
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Stuart J Pocock
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Michael Lu
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Roseann White
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Molly Szerlip
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Julien Ternacle
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - S Chris Malaisrie
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Howard C Herrmann
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Wilson Y Szeto
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Mark J Russo
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Vasilis Babaliaros
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Craig R Smith
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Philipp Blanke
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - John G Webb
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
| | - Raj Makkar
- From Baylor Scott and White Health, Plano, TX (M.J.M., M.S.); Columbia University (M.B.L., R.T.H., S.H.K., C.R.S.) and the Cardiovascular Research Foundation (M.B.L., R.T.H., S.H.K., D.J.C., C.R.S.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; Marcus Heart Valve Center, Piedmont Heart Institute (V.H.T.), and Emory University (V.B.) - both in Atlanta; Laval University, Quebec, QC (P.P.), and St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.G.W.) - both in Canada; Morristown Medical Center, Morristown (P.G.), and Robert Wood Johnson University Hospital, New Brunswick (M.J.R.) - both in New Jersey; Cleveland Clinic, Cleveland (S.R.K.); London School of Hygiene and Tropical Medicine, London (S.J.P.); Edwards Lifesciences, Irvine (M.L., R.W.), and Cedars-Sinai Medical Center, Los Angeles (R.M.) - both in California; Heart Valve Unit, Haut-Lévêque Cardiological Hospital, Bordeaux University, Pessac, France (J.T.); Northwestern University, Chicago (S.C.M.); and the University of Pennsylvania, Philadelphia (H.C.H., W.Y.S.)
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Heuts S, Kawczynski MJ, Sardari Nia P, Maessen JG, Biondi-Zoccai G, Gabrio A. Bayesian interpretation of non-inferiority in transcatheter versus surgical aortic valve replacement trials: a systematic review and meta-analysis. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2023; 37:ivad185. [PMID: 37982737 PMCID: PMC10684360 DOI: 10.1093/icvts/ivad185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES The concept of non-inferiority is widely adopted in randomized trials comparing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). However, uncertainty exists regarding the long-term outcomes of TAVR, and non-inferiority may be difficult to assess. We performed a systematic review and meta-analysis of randomized trials comparing TAVR and SAVR, with a specific emphasis on the non-inferiority margin for 5-year all-cause mortality. METHODS A systematic search was applied to 3 electronic databases. Randomized trials comparing TAVR and SAVR were included. Bayesian methods were implemented to evaluate the posterior probability of non-inferiority at different trial non-inferiority margins under either a vague, Cauchy, or a literature-based prior. Primary outcomes were 5-year actuarial all-cause mortality, and the probability of non-inferiority at various transformed trial non-inferiority margins. Secondary outcomes were long-term survival and 1- and 2-year actuarial survival. RESULTS Eight trials (n = 8698 patients) were included. Kaplan-Meier-derived 5-year survival was 61.6% (95% CI 59.8-63.5%) for TAVR, and 63.7% (95% CI 61.9-65.6%) for SAVR. Six trials (n = 6370 patients) reported all-cause mortality at 5-year follow-up. Under a vague prior, the posterior median relative risk for all-cause mortality of TAVR was 1.14, compared to SAVR (95% credible interval 1.06-1.22, probability of relative risk <1.00 = 0.01%, I2 = 0%). Similar results in terms of point estimate and uncertainty measures were obtained using frequentist methods. Based on the various trial non-inferiority margins, the results of the analysis suggest that non-inferiority at 5 years is no longer likely. CONCLUSIONS It is unlikely that TAVR is still non-inferior to SAVR at 5 years in terms of all-cause mortality.
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Affiliation(s)
- Samuel Heuts
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Michal J Kawczynski
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre+, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, Netherlands
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Rome, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Andrea Gabrio
- Department of Methodology and Statistics, Maastricht University, Maastricht, Netherlands
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Seiffert M, Vonthein R, Baumgartner H, Borger MA, Choi YH, Falk V, Frey N, Hagendorff A, Hagl C, Hamm C, König IR, Landmesser U, Massberg S, Reichenspurner H, Thiele H, Twerenbold R, Vens M, Walther T, Ziegler A, Cremer J, Blankenberg S. Transcatheter aortic valve implantation versus surgical aortic valve replacement in patients at low to intermediate surgical risk: rationale and design of the randomised DEDICATE Trial. EUROINTERVENTION 2023; 19:652-658. [PMID: 37655862 PMCID: PMC10587839 DOI: 10.4244/eij-d-23-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 09/02/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the preferred treatment option for patients with severe aortic stenosis at increased risk for surgical aortic valve replacement (SAVR) and for older patients irrespective of risk. However, in younger, low-risk patients for whom both therapeutic options, TAVI and SAVR, are applicable, the optimal treatment strategy remains controversial, as data on long-term outcomes remain limited. The DEDICATE-DZHK6 Trial is an investigator-initiated, industry-independent, prospective, multicentre, randomised controlled trial investigating the efficacy and safety of TAVI compared to SAVR in low- to intermediate-risk patients aged 65 years or older. To evaluate both treatment strategies, approximately 1,404 patients determined eligible for both TAVI and SAVR by the interdisciplinary Heart Team were randomised to TAVI or SAVR. Broad inclusion and strict exclusion criteria targeted an all-comers patient population. Procedures were performed according to local best practice with contemporary routine medical devices. The primary endpoints are a composite of mortality or stroke at 1 year and 5 years in order to incorporate midterm efficacy results and complement early safety data. Primary outcomes will be tested sequentially for non-inferiority and superiority. The DEDICATE-DZHK6 Trial has been designed to mirror clinical reality for the treatment of severe aortic stenosis and provide unique information on overall outcomes after TAVI and SAVR that can be directly applied to clinical routines. Its results will help further define optimal treatment strategies for low- to intermediate-risk patients in whom both TAVI and SAVR are currently advisable.
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Affiliation(s)
- Moritz Seiffert
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Helmut Baumgartner
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Muenster, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Klinik, Bad Nauheim, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Rhine-Main, Rhine-Main, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
- Department of Health Sciences & Technology, ETH Zurich, Translational Cardiovascular Technology, Zurich, Switzerland
| | - Norbert Frey
- Department of Cardiology, Angiology, and Pneumology, Heidelberg University Hospital, Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim, Heidelberg, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Munich Heart Alliance, Munich, Germany
| | - Christian Hamm
- DZHK (German Centre for Cardiovascular Research) partner site Rhine-Main, Rhine-Main, Germany
- Campus Kerckhoff and Medical Clinic I, University of Giessen, Giessen, Germany
| | - Inke R König
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Ulf Landmesser
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Steffen Massberg
- Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Cardiology, University Hospital Munich, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Hermann Reichenspurner
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany and Leipzig Heart Science, Leipzig, Germany
| | - Raphael Twerenbold
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Maren Vens
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Thomas Walther
- DZHK (German Centre for Cardiovascular Research) partner site Rhine-Main, Rhine-Main, Germany
- Department of Thoracic and Cardiovascular Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andreas Ziegler
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Cardio-CARE, Medizincampus Davos, Davos, Switzerland
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Jochen Cremer
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Centre for Population Health Innovation (POINT), University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Centre for Cardiovascular Research) partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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Kermanshahchi J, Thind B, Davoodpour G, Hirsch M, Chen J, Reddy AJ, Chan E, Yu Z, Javidi D. A Review of the Cost Effectiveness of Transcatheter Aortic Valve Replacement (TAVR) Versus Surgical Aortic Valve Replacement (SAVR). Cureus 2023; 15:e46535. [PMID: 37927639 PMCID: PMC10625447 DOI: 10.7759/cureus.46535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Abstract
The cost of transcatheter aortic valve replacement (TAVR) has been studied in the context of high-risk or specific comorbidity populations; this paper provides a comprehensive overview of broader patient populations' outcomes and costs with TAVR in comparison to surgical aortic valve replacement (SAVR). In the past, SAVR had been the more cost-effective option than TAVR, but in recent years, TAVR has been becoming more cost-effective.Though the cost of TAVR can vary due to several factors the major focus of this review will focus on the surgical technique, medicare reimbursements, insertion point, and varying risk populations. In conclusion, the price of TAVR is declining as more cost-efficient valves arrive on the market. Climbing healthcare costs play a significant role in clinical decisions when deciding on which procedures are most cost-effective for the patient and healthcare system. The declining price of TAVR could lead to the preference of TAVR over SAVR for both low-risk and high-risk aortic stenosis patients.
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Affiliation(s)
| | - Birpartap Thind
- Medicine, California University of Science and Medicine, Colton, USA
| | | | - Megan Hirsch
- Medicine, California University of Science and Medicine, Colton, USA
| | - Jeff Chen
- Medicine, California University of Science and Medicine, Colton, USA
| | - Akshay J Reddy
- Medicine, California University of Science and Medicine, Colton, USA
| | - Evan Chan
- Medicine, California Northstate University, Elk Grove, USA
| | - Zeyu Yu
- Medicine, California Health Science University, Clovis, USA
| | - Daryoush Javidi
- Medical Education, California University of Science and Medicine, Colton, USA
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Kotit S. Secondary analysis of REPRISE III trial: The Lotus valve's persistence after withdrawal. Glob Cardiol Sci Pract 2023; 2023:e202330. [PMID: 38404629 PMCID: PMC10886713 DOI: 10.21542/gcsp.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/12/2023] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION Aortic stenosis (AS) is the leading heart valve disease in developed countries, often caused by calcific degeneration. In low-and-middle-income countries, it's primarily due to RHD. Prevalence of AS increases with age and up to 22.8% of those affected over the age of 75. While surgical aortic valve replacement is standard treatment for AS, many older individuals are not ideal candidates. Transcatheter aortic valve replacement (TAVR) offers an alternative. The REPRISE III trial showed the Lotus valve outperformed the CoreValve/EvolutR TAVR valves in various metrics over 2 years. Despite its success and over 10,000 implantations, the Lotus valve was pulled from the market, highlighting the need to understand its long-term outcomes. Study and results: In the REPRISE III trial, the long-term outcomes of TAVR using the Lotus valve were compared to the CoreValve/EvolutR over 5 years across 55 global centers. Of the participants, 581 (95.7%) used the Lotus valve and 285 (93.4%) used CoreValve/EvolutR. Event rates for all-cause mortality were similar between the groups, but the Lotus valve group had lower rates of disabling stroke and pacemaker implantation. The Lotus valve showed a higher aortic gradient but lower effective orifice area. Additionally, the Lotus valve had reduced mild PVL, valve malpositioning, and the need for a second valve. Both groups showed comparable long-term improvements in heart and cardiomyopathy assessments. LESSONS LEARNED The REPRISE III analysis highlights the favourable long-term outcomes of the Lotus valve and CoreValve/EvolutR for high-risk surgical patients. These findings underscore the importance of ongoing management post-valve procedure and the potential advantages of the Lotus valve design. Further studies comparing these valves to surgery will inform aortic stenosis management and potentially expand TAVR indications. The future goal is to develop a tissue-engineered living heart valve to improve survival and quality of life.
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Lerman TT, Levi A, Jørgensen TH, Søndergaard L, Talmor-Barkan Y, Kornowski R. Comparison of middle-term valve durability between transcatheter aortic valve implantation and surgical aortic valve replacement: an updated systematic review and meta-analysis of RCTs. Front Cardiovasc Med 2023; 10:1242608. [PMID: 37771663 PMCID: PMC10525352 DOI: 10.3389/fcvm.2023.1242608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
Background This study aims to compare valve durability between transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). Methods We conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The primary outcome was structural valve deterioration (SVD). Secondary outcomes were bioprosthetic valve failure, reintervention, effective orifice area (EOA), mean pressure gradient, and moderate-severe aortic regurgitation (AR, transvalvular and/or paravalvular). Results Twenty-five publications from seven RCTs consisting of 7,970 patients were included in the analysis with follow-up ranges of 2-8 years. No significant difference was found between the two groups with regard to SVD [odds ratio (OR) 0.72; 95% CI: 0.25-2.12]. The TAVI group was reported to exhibit a statistically significant higher risk of reintervention (OR 2.03; 95% CI: 1.34-3.05) and a moderate-severe AR (OR 6.54; 95% CI: 3.92-10.91) compared with the SAVR group. A trend toward lower mean pressure gradient in the TAVI group [(mean difference (MD) -1.61; 95% CI: -3.5 to 0.28)] and significant higher EOA (MD 0.20; 95% CI: 0.08-0.31) was noted. Conclusion The present data indicate that TAVI provides a comparable risk of SVD with favorable hemodynamic profile compared with SAVR. However, the higher risk of significant AR and reintervention was demonstrated. Systematic Review Registration PROSPERO (CRD42022363060).
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Affiliation(s)
- Tsahi T. Lerman
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Troels Højsgaard Jørgensen
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel
- The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Newell P, Javadikasgari H, Rojas-Alexandre M, Hirji S, Harloff M, Cherkasky O, McGurk S, Malarczyk A, Shah P, Sabe A, Kaneko T. All-cause procedural readmissions following transcatheter aortic valve replacement. JTCVS OPEN 2023; 15:83-93. [PMID: 37808066 PMCID: PMC10556937 DOI: 10.1016/j.xjon.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 10/10/2023]
Abstract
Objective With expanding eligibility criteria, transcatheter aortic valve replacement is being performed on patients with longer life expectancy, and subsequent procedures after index transcatheter aortic valve replacement are inevitable. This study examines the incidence and outcomes of patients undergoing subsequent procedural readmissions after transcatheter aortic valve replacement. Methods All patients who underwent index transcatheter aortic valve replacement and were discharged alive from January 2012 to December 2019 at a single institution were evaluated. Study end points were mortality and readmission for procedure with more than 1-day hospital stay. Effect on survival was evaluated by treating procedural readmission as a time-dependent variable by Cox proportional hazard model and competing risk analysis. Results A total of 1092 patients met inclusion criteria with a median follow-up time of 34 months. A total of 218 patients (20.0%) had 244 subsequent procedural readmissions. During the 244 procedural readmissions, there were 260 procedures; 96 (36.9%) were cardiac (most commonly pacemaker implantation, percutaneous coronary interventions, and surgical aortic valve replacements), and 164 (63.1%) were noncardiac (most commonly orthopedic and gastrointestinal procedures). The overall procedural readmission rates were 32%, 39%, and 42%, and all-cause mortality was 27%, 44%, and 54% at 20, 40, and 60 months, respectively. Procedural readmissions were not associated with a survival penalty in any surgical risk group or on Cox regression (hazard ratio, 1.25; 0.91-1.64, P = .17). Conclusions After transcatheter aortic valve replacement, procedural interventions are seen frequently, with most procedures occurring within the first year after transcatheter aortic valve replacement. However, subsequent procedural readmissions do not appear to have a survival penalty for patients after transcatheter aortic valve replacement. After transcatheter aortic valve replacement with resolution of aortic stenosis, subsequent procedures can and should be pursued if they are needed.
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Affiliation(s)
- Paige Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Mehida Rojas-Alexandre
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sameer Hirji
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Morgan Harloff
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Olena Cherkasky
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Alexandra Malarczyk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Pinak Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Ashraf Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Washington University School of Medicine, St Louis, Mo
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Postolache A, Sperlongano S, Lancellotti P. TAVI after More Than 20 Years. J Clin Med 2023; 12:5645. [PMID: 37685712 PMCID: PMC10489114 DOI: 10.3390/jcm12175645] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
It has been more than 20 years since the first in man transcatheter aortic valve intervention (TAVI), and during this period we have witnessed an impressive evolution of this technique, with an extension of its use from non-operable patients to high-, intermediate- and even low-risk patients with aortic stenosis, and with a decrease in the incidence of complications. In this review, we discuss the evaluation of patients before TAVI, the procedure and the changes it has seen over time, and we present the current main complications and challenges of TAVI.
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Affiliation(s)
- Adriana Postolache
- Cardiology Department, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, 4000 Liège, Belgium;
| | - Simona Sperlongano
- Devision of Cardiology, Department of Translational Medical Sciences, University of Campania Luigi VanVitelli, 80131 Naples, Italy;
| | - Patrizio Lancellotti
- Cardiology Department, GIGA Cardiovascular Sciences, University of Liège Hospital, CHU Sart Tilman, 4000 Liège, Belgium;
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Gerfer S, Eghbalzadeh K, Brinkschröder S, Djordjevic I, Rustenbach C, Rahmanian P, Mader N, Kuhn E, Wahlers T. Is It Reasonable to Perform Isolated SAVR by Residents in the TAVI Era? Thorac Cardiovasc Surg 2023; 71:376-386. [PMID: 34808679 DOI: 10.1055/s-0041-1736206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The role of conventional surgical aortic valve replacement (SAVR) is increasingly questioned since the indication for transcatheter aortic valve implantations (TAVIs) is currently extended. While the number of patients referred to SAVR decreases, it is unclear if SAVR should be performed by junior resident surgeons in the course of a heart surgeons training. METHODS Patients with isolated aortic valve replacement (AVR) were analyzed with respect to the surgeon's qualification. AVR performed by resident surgeons was compared with AVR by senior surgeons. The collective was analyzed with respect to clinical short-term outcomes comparing full sternotomy (FS) with minimally invasive surgery and ministernotomy (MS) with right anterior thoracotomy (RAT) after a 1:1 propensity score matching. RESULTS The 30-day all-cause mortality was 2.3 and 3.4% for resident versus senior AVR groups, cerebrovascular event rates were 1.1 versus 2.6%, and no cases of significant paravalvular leak were detected. Clinical short-term outcomes between FS and minimally invasive access, as well after MS and RAT were comparable. CONCLUSION Our current data show feasibility and safety of conventional SAVR procedure performed by resident surgeons in the era of TAVI. Minimally invasive surgery should be trained and performed in higher volumes early in the educational process as it is a safe treatment option.
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Affiliation(s)
- Stephen Gerfer
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Sarah Brinkschröder
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Christian Rustenbach
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Parwis Rahmanian
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Navid Mader
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center, University Hospital of Cologne, Cologne, Germany
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Masraf H, Sef D, Chin SL, Hunduma G, Trkulja V, Miskolczi S, Velissaris T, Luthra S. Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience. J Clin Med 2023; 12:4841. [PMID: 37510956 PMCID: PMC10381828 DOI: 10.3390/jcm12144841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of octogenarians undergoing isolated AVR and AVR + CABG. METHODS All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival. RESULTS A total of 1011 patients who underwent AVR (83.0 [81.0-85.0] years, 42.0% males) and 1055 with AVR + CABG (83.0 [81.2-85.4] years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years [IQR: 6.7-7.5] vs. 6.6 years [IQR: 6.3-7.2], respectively, p = 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06-1.12, p < 0.001), previous MI (HR: 2.08; 95% CI: 1.32-3.28, p = 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33-3.23, p = 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04-1.10, p < 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15-1.89, p = 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77-1.02, p = 0.09). CONCLUSIONS The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.
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Affiliation(s)
- Hannah Masraf
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Davorin Sef
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Sirr Ling Chin
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Gabriel Hunduma
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | | | - Szabolcs Miskolczi
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Theodore Velissaris
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
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Jabbour RJ, Curzen N. How long will my TAVI valve last, doctor? Expert Rev Cardiovasc Ther 2023; 21:721-724. [PMID: 37883125 DOI: 10.1080/14779072.2023.2276366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/24/2023] [Indexed: 10/27/2023]
Affiliation(s)
- Richard J Jabbour
- Wessex Cardiothoracic Centre, Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Curzen
- Wessex Cardiothoracic Centre, Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Prieto-Lobato A, Nuche J, Avvedimento M, Paradis JM, Dumont E, Kalavrouziotis D, Mohammadi S, Rodés-Cabau J. Managing the challenge of a small aortic annulus in patients with severe aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:747-761. [PMID: 37869793 DOI: 10.1080/14779072.2023.2271395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Small aortic annulus (SAA) poses a challenge in the management of patients with severe aortic stenosis requiring aortic valve replacement - both surgical and transcatheter - since it has been associated with worse clinical outcomes. AREAS COVERED This review aims to comprehensively summarize the available evidence regarding the management of aortic stenosis in patients with SAA and discuss the current controversies as well as future perspectives in this field. EXPERT OPINION It is paramount to agree in a common definition for diagnosing and properly treating SAA patients, and for that purpose, multidetector computer tomography is essential. The results of recent trials led to the expansion of transcatheter aortic valve replacement among patients of all the surgical-risk spectrum, and the choice of treatment (transcatheter, surgical) should be based on patient comorbidities, anatomical characteristics, and patient preferences.
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Affiliation(s)
- Alicia Prieto-Lobato
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Hospital del Mar, Barcelona, Spain
| | - Jorge Nuche
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Clínic Barcelona, Barcelona, Spain
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45
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Kim H, Kang DY, Ahn JM, Kim JB, Yeung AC, Nishi T, Fearon WF, Cantey EP, Flaherty JD, Davidson CJ, Malaisrie SC, Kim N, Kim M, Lee J, Park J, Choi Y, Park SJ, Park DW. Race-Specific Impact of Conventional Surgical Risk Score on 1-Year Mortality After Transcatheter Aortic Valve Replacement. JACC. ASIA 2023; 3:376-387. [PMID: 37323869 PMCID: PMC10261892 DOI: 10.1016/j.jacasi.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/31/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Background Interracial differences in the distribution and prognostic value of conventional Society of Thoracic Surgeons (STS) score on long-term mortality after transcatheter aortic valve replacement (TAVR) are uncertain. Objectives This study aims to compare the impact of STS scores on clinical outcomes at 1-year after TAVR between Asian and non-Asian populations. Methods We used the Trans-Pacific TAVR (TP-TAVR) registry, a multinational multicenter, observational registry involving patients undergoing TAVR at 2 major centers in the United States and 1 major center in Korea. Patients were classified into 3 groups (low, intermediate, and high-risk) according to the STS score and compared between STS risk groups and race. The primary outcome was all-cause mortality at 1-year. Results Among 1,412 patients, 581 were Asian and 831 were non-Asian. The distribution of the STS risk score group was different between Asian and non-Asian groups (62.5% low-, 29.8% intermediate-, and 7.7% high-risk in Asian vs 40.6% low-, 39.1% intermediate-, and 20.3% high-risk in non-Asian). In the Asian population, the all-cause mortality at 1-year was substantially higher in the high-risk STS group than in the low- and intermediate-risk groups (3.6% low-risk, 8.7% intermediate-risk, and 24.4% high-risk; log-rank P < 0.001), which was primarily driven by noncardiac mortality. In the non-Asian group, there was a proportional increase in all-cause mortality at 1-year according to the STS risk category (5.3% low-risk, 12.6% intermediate-risk, and 17.8% high-risk; log-rank P < 0.001). Conclusions In this multiracial registry of patients with severe aortic stenosis who underwent TAVR, we identified a differential proportion and prognostic impact of STS score on 1-year mortality between Asian and non-Asian patients (TP-TAVR [Transpacific TAVR Registry]; NCT03826264).
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Affiliation(s)
- Hoyun Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Do-Yoon Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jung-Min Ahn
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Juyong Brian Kim
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Alan C. Yeung
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Takeshi Nishi
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - William F. Fearon
- Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Eric P. Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - James D. Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Charles J. Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - S. Christopher Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Chicago, Illinois, USA
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mijin Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinho Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jinsun Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeonwoo Choi
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung-Jung Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Duk-Woo Park
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Schaeffer T, Koechlin L, Jeger R, Leibundgut G, Reuthebuch O. Severe structural valve deterioration after TAVR with ACURATE Neo: report of two cases. Front Cardiovasc Med 2023; 10:1135496. [PMID: 37304949 PMCID: PMC10248160 DOI: 10.3389/fcvm.2023.1135496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/03/2023] [Indexed: 06/13/2023] Open
Abstract
Structural valve deterioration (SVD) of transcatheter implanted aortic valve (TAVR) prostheses leading to prosthesis dysfunction is an uncommon yet increasingly described complication. Literature is scarce on specific mechanisms and clinical presentation of SVD after TAVR, notably on self-expanding valve ACURATE Neo. We report on two cases with severe bioprosthetic failure after ACURATE Neo implantation due to leaflet disruption, and we treated them with surgical aortic valve replacement. Based on the literature, we further discuss the incidence of SVD after TAVR, the durability of ACURATE NEO, and the modes of failure of biological valve prostheses.
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Affiliation(s)
- Thibault Schaeffer
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luca Koechlin
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Leibundgut
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, University Hospital Basel, University of Basel, Basel, Switzerland
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Maisano F, Thiele H, Fichtlscherer S, Westermann D, Hakmi S, Kempfert J, Bedogni F, Yong G, Bates N, Søndergaard L. 3-Year Outcomes of Transcatheter Aortic Valve Replacement: Insights From the PORTICO I Registry. JACC Cardiovasc Interv 2023; 16:1313-1315. [PMID: 37225307 DOI: 10.1016/j.jcin.2023.02.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 05/26/2023]
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Montarello NJ, Willemen Y, Tirado-Conte G, Travieso A, Bieliauskas G, Sondergaard L, De Backer O. Transcatheter aortic valve durability: a contemporary clinical review. Front Cardiovasc Med 2023; 10:1195397. [PMID: 37229228 PMCID: PMC10203628 DOI: 10.3389/fcvm.2023.1195397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Encouraged by randomized controlled trials demonstrating non-inferiority of transfemoral transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) across all surgical risk categories, there has been a dramatic increase in the use of TAVI in a younger patient cohort with severe aortic stenosis, endorsed by both European and American Cardiac Societies. However, the standard use of TAVI in younger, less co-morbid patients with a longer life expectancy can only be supported if there is sound data demonstrating long-term durability of transcatheter aortic valves (TAVs). In this article, we have reviewed available randomized and observational registry clinical data pertaining to TAV long-term durability, placing emphasis on trials and registries using the new standardized definitions of bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF). Despite inherent difficulties in interpreting the available data, the determination reached is that the risk of structural valve deterioration (SVD) is potentially lower after TAVI than SAVR at 5 to 10 years, and that the two treatment modalities have a similar risk of BVF. This supports the adoption of TAVI in younger patients evident in current practice. However, the routine use of TAVI in younger patients with bicuspid aortic valve stenosis should be cautioned due to insufficient long-term TAV durability data in this particular patient population. Finally, we highlight the importance of future research into the unique potential mechanisms that can potentially contribute to TAV degeneration.
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49
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Forrest JK, Deeb GM, Yakubov SJ, Gada H, Mumtaz MA, Ramlawi B, Bajwa T, Teirstein PS, DeFrain M, Muppala M, Rutkin BJ, Chawla A, Jenson B, Chetcuti SJ, Stoler RC, Poulin MF, Khabbaz K, Levack M, Goel K, Tchétché D, Lam KY, Tonino PAL, Ito S, Oh JK, Huang J, Popma JJ, Kleiman N, Reardon MJ. 3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. J Am Coll Cardiol 2023; 81:1663-1674. [PMID: 36882136 DOI: 10.1016/j.jacc.2023.02.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low-surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate patients as part of a shared decision-making process. OBJECTIVES The authors evaluated 3-year clinical and echocardiographic outcomes from the Evolut Low Risk trial. METHODS Low-risk patients were randomized to TAVR with a self-expanding, supra-annular valve or surgery. The primary endpoint of all-cause mortality or disabling stroke and several secondary endpoints were assessed at 3 years. RESULTS There were 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had a mean age of 74 years and 35% were women. At 3 years, the primary endpoint occurred in 7.4% of TAVR patients and 10.4% of surgery patients (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). The difference between treatment arms for all-cause mortality or disabling stroke remained broadly consistent over time: -1.8% at year 1; -2.0% at year 2; and -2.9% at year 3. The incidence of mild paravalvular regurgitation (20.3% TAVR vs 2.5% surgery) and pacemaker placement (23.2% TAVR vs 9.1% surgery; P < 0.001) were lower in the surgery group. Rates of moderate or greater paravalvular regurgitation for both groups were <1% and not significantly different. Patients who underwent TAVR had significantly improved valve hemodynamics (mean gradient 9.1 mm Hg TAVR vs 12.1 mm Hg surgery; P < 0.001) at 3 years. CONCLUSIONS Within the Evolut Low Risk study, TAVR at 3 years showed durable benefits compared with surgery with respect to all-cause mortality or disabling stroke. (Medtronic Evolut Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
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Affiliation(s)
- John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA.
| | - G Michael Deeb
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | - Hemal Gada
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Mubashir A Mumtaz
- University of Pittsburgh Medical Center, Harrisburg, Pennsylvania, USA
| | - Basel Ramlawi
- Lankenau Heart Institute, Philadelphia, Pennsylvania, USA
| | - Tanvir Bajwa
- Aurora St Luke's Medical Center, Milwaukee, Wisconsin, USA
| | | | | | | | - Bruce J Rutkin
- North Shore University Hospital, Manhasset, New York, USA
| | - Atul Chawla
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Bart Jenson
- Mercy Medical Center, Iowa Heart, Des Moines, Iowa, USA
| | - Stanley J Chetcuti
- University of Michigan Health Systems University Hospital, Ann Arbor, Michigan, USA
| | | | | | - Kamal Khabbaz
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Levack
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kashish Goel
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Ka Yan Lam
- Catharina Ziekenhuis, Eindhoven, the Netherlands
| | | | - Saki Ito
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Echocardiography Core Laboratory, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Neal Kleiman
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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50
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Hawkins RB, Deeb GM, Sukul D, Patel HJ, Gualano SK, Chetcuti SJ, Grossman PM, Ailawadi G, Fukuhara S. Redo Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement. JACC Cardiovasc Interv 2023; 16:942-953. [PMID: 37100557 DOI: 10.1016/j.jcin.2023.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Aortic stenosis treatment should consider risks and benefits for lifetime management. Although the feasibility of redo transcatheter aortic valve replacement (TAVR) remains unclear, concerns are emerging regarding reoperation after TAVR. OBJECTIVES The authors sought to define comparative risk of surgical aortic valve replacement (SAVR) after prior TAVR or SAVR. METHODS Data on patients undergoing bioprosthetic SAVR after TAVR and/or SAVR were extracted from the Society of Thoracic Surgeons Database (2011-2021). Overall and isolated SAVR cohorts were analyzed. The primary outcome was operative mortality. Risk adjustment using hierarchical logistic regression as well as propensity score matching for isolated SAVR cases were performed. RESULTS Of 31,106 SAVR patients, 1,126 had prior TAVR (TAVR-SAVR), 674 had prior SAVR and TAVR (SAVR-TAVR-SAVR), and 29,306 had prior SAVR (SAVR-SAVR). Yearly rates of TAVR-SAVR and SAVR-TAVR-SAVR increased over time, whereas SAVR-SAVR was stable. The TAVR-SAVR patients were older, with higher acuity, and with greater comorbidities than other cohorts. The unadjusted operative mortality was highest in the TAVR-SAVR group (17% vs 12% vs 9%, respectively; P < 0.001). Compared with SAVR-SAVR, risk-adjusted operative mortality was significantly higher for TAVR-SAVR (OR: 1.53; P = 0.004), but not SAVR-TAVR-SAVR (OR: 1.02; P = 0.927). After propensity score matching, operative mortality of isolated SAVR was 1.74 times higher for TAVR-SAVR than SAVR-SAVR patients (P = 0.020). CONCLUSIONS The number of post-TAVR reoperations is increasing and represent a high-risk population. Yet even in isolated SAVR cases, SAVR after TAVR is independently associated with increased risk of mortality. Patients with life expectancy beyond a TAVR valve and unsuitable anatomy for redo-TAVR should consider a SAVR-first approach.
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Affiliation(s)
- Robert B Hawkins
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Devraj Sukul
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah K Gualano
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Stanley J Chetcuti
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - P Michael Grossman
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA; Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
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