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Ternacle J, Guimaraes L, Vincent F, Côté N, Côté M, Lachance D, Clavel MA, Abbas AE, Pibarot P, Rodés-Cabau J. Reclassification of prosthesis-patient mismatch after transcatheter aortic valve replacement using predicted vs. measured indexed effective orifice area. Eur Heart J Cardiovasc Imaging 2021; 22:11-20. [PMID: 32995865 DOI: 10.1093/ehjci/jeaa235] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Indexed: 12/16/2022] Open
Abstract
AIMS The objective was to compare the incidence and impact on outcomes of measured (PPMM) vs. predicted (PPMP) prosthesis-patient mismatch following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS All consecutives patients who underwent TAVR between 2007 and 2018 were included. Effective orifice area (EOA) was measured by Doppler-echocardiography using the continuity equation and predicted according to the normal reference for each model and size of valve. PPM was defined using EOA indexed (EOAi) to body surface area as moderate if ≤0.85 cm2/m2 and severe if ≤ 0.65 cm2/m2 (respectively, ≤ 0.70 and ≤ 0.55 cm2/m2 if body mass index ≥ 30 kg/m2). The outcome endpoints were high residual gradient (≥20 mmHg) and the composite of cardiovascular mortality and hospital readmission for heart failure at 1 year. Overall, 1088 patients underwent a TAVR (55% male, age 79.1 ± 8.4 years, and STS score 6.6 ± 4.7%); balloon-expandable device was used in 83%. Incidence of moderate (10% vs. 27%) and severe (1% vs. 17%) PPM was markedly lower when defined by predicted vs. measured EOAi (P < 0.001). Balloon-expandable device implantation (OR: 1.90, P = 0.029) and valve-in-valve procedure (n = 118; OR: 3.21, P < 0.001) were the main factors associated with PPM occurrence. Compared with measured PPM, predicted PPM showed stronger association with high residual gradient. Severe measured or predicted PPM was not associated with clinical outcomes. CONCLUSION The utilization of the predicted EOAi reclassifies the majority of patients with PPM to no PPM following TAVR. Compared with measured PPM, predicted PPM had stronger association with haemodynamic outcomes, while both methods were not associated with clinical outcomes.
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Affiliation(s)
- Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Cardiology Department, Expert Valve Center, Henri Mondor ho spital, 51 avenue du Maréchal de Lattre de Tassigny, 94000, Créteil, France
- INSERM Unit U955, Team 8, Paris-Est Creteil University, Val-de-Marne, 8 rue du Général Sarrail, 94010, Créteil, France
| | - Leonardo Guimaraes
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Flavien Vincent
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
- Département de cardiologie, CHU de Lille, Institut Cœur Poumon, Université de Lille, INSERM U1011, Institut Pasteur de Lille, EGID, Boulevard du Professeur Jules Leclercq, 59000 Lille,, France
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Mélanie Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Dominique Lachance
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, 586 Pioneer Dr, Rochester, MI 48309, USA
- Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec- Université Laval/Québec Heart and Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec city, Québec G1V-4G5, Canada
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2
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Ternacle J, Pibarot P, Herrmann HC, Kodali S, Leipsic J, Blanke P, Jaber W, Mack MJ, Clavel MA, Salaun E, Guzzetti E, Annabi MS, Bernier M, Beaudoin J, Khalique OK, Weissman NJ, Douglas P, Bax J, Dahou A, Xu K, Alu M, Rogers E, Leon M, Thourani VH, Abbas AE, Hahn RT. Prosthesis-Patient Mismatch After Aortic Valve Replacement in the PARTNER 2 Trial and Registry. JACC Cardiovasc Interv 2021; 14:1466-1477. [PMID: 34238557 DOI: 10.1016/j.jcin.2021.03.069] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to compare incidence and impact of measured prosthesis-patient mismatch (PPMM) versus predicted PPM (PPMP) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR). BACKGROUND TAVR studies have used measured effective orifice area indexed (EOAi) to body surface area (BSA) to define PPM, but most SAVR series have used predicted EOAi. This difference may contribute to discrepancies in incidence and outcomes of PPM between series. METHODS The study analyzed SAVR patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2A trial and TAVR patients from the PARTNER 2 SAPIEN 3 Intermediate Risk registry. PPM was classified as moderate if EOAi ≤0.85 cm2/m2 (≤0.70 if obese: body mass index ≥30 kg/m2) and severe if EOAi ≤0.65 cm2/m2 (≤0.55 if obese). PPMM was determined by the core lab-measured EOAi on 30-day echocardiogram. PPMP was determined by 2 methods: 1) using normal EOA reference values previously reported for each valve model and size (PPMP1; n = 929 SAVR, 1,069 TAVR) indexed to BSA; and 2) using normal reference EOA predicted from aortic annulus size measured by computed tomography (PPMP2; n = 864 TAVR only) indexed to BSA. Primary endpoint was the composite of 5-year all-cause death and rehospitalization. RESULTS The incidence of moderate and severe PPMP was much lower than PPMM in both SAVR (PPMP1: 28.4% and 1.2% vs. PPMM: 31.0% and 23.6%) and TAVR (PPMP1: 21.0% and 0.1% and PPMP2: 17.0% and 0% vs. PPMM: 27.9% and 5.7%). The incidence of severe PPMM and severe PPMP1 was lower in TAVR versus SAVR (P < 0.001). The presence of PPM by any method was associated with higher transprosthetic gradient. Severe PPMP1 was independently associated with events in SAVR after adjustment for sex and Society of Thoracic Surgeons score (hazard ratio: 3.18;95% CI: 1.69-5.96; P < 0.001), whereas no association was observed between PPM by any method and outcomes in TAVR. CONCLUSIONS EOAi measured by echocardiography results in a higher incidence of PPM following SAVR or TAVR than PPM based on predicted EOAi. Severe PPMP is rare (<1.5%), but is associated with increased all-cause death and rehospitalization after SAVR, whereas it is absent following TAVR.
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Affiliation(s)
- Julien Ternacle
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada.
| | - Howard C Herrmann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jonathon Leipsic
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Marie-Annick Clavel
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Erwan Salaun
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | | | - Mathieu Bernier
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Jonathan Beaudoin
- Québec Heart and Lung Institute, Université Laval, Quebec City, Quebec, Canada
| | - Omar K Khalique
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Neil J Weissman
- MedStar Heath Research Institute, Georgetown University, Washington, DC, USA
| | - Pamela Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Ke Xu
- Edwards Lifesciences, Irvine, California, USA
| | - Maria Alu
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Erin Rogers
- Edwards Lifesciences, Irvine, California, USA
| | - Martin Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Amr E Abbas
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA; Beaumont Hospital Royal Oak, Royal Oak, Michigan, USA
| | - Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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3
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Côté N, Clavel MA. Sex Differences in the Pathophysiology, Diagnosis, and Management of Aortic Stenosis. Cardiol Clin 2020; 38:129-138. [DOI: 10.1016/j.ccl.2019.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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4
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Herrmann HC, Daneshvar SA, Fonarow GC, Stebbins A, Vemulapalli S, Desai ND, Malenka DJ, Thourani VH, Rymer J, Kosinski AS. Prosthesis–Patient Mismatch in Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2018; 72:2701-2711. [DOI: 10.1016/j.jacc.2018.09.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 10/28/2022]
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5
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Raimundo R, Moreira S, Saraiva F, Cerqueira RJ, Teixeira P, Salgueiro E, Lourenço A, Amorim MJ, Almeida J, Pinho P, Leite-Moreira AF. Early and mid-term haemodynamic performance and clinical outcomes of St. Jude Medical Trifecta™ valve. J Thorac Dis 2018; 10:889-898. [PMID: 29607162 DOI: 10.21037/jtd.2018.01.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background New models of aortic bioprostheses have proven excellent early haemodynamic profile, but their mid and long-term performance warrants further systematic assessment. The aim of this study is to report clinical and haemodynamic performance of St. Jude Medical Trifecta bioprosthesis during 5 years of implantation. Methods We performed a single centre, retrospective, observational and descriptive study including all 556 individuals who underwent aortic valve replacement (AVR) with the Trifecta bioprosthesis (between July of 2011 and June of 2016). Survival and re-intervention were censored in February 2017. Postoperative ambulatory echocardiographic data was available for 490 patients. A complete clinical follow-up was available in 463 individuals (mean follow-up time, 27±17 months). Results In our sample the mean age was 73±9 years, 57.6% were male and median European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 2.9 (interquartile range, 1.6-5.8). There were 301 (54.1%) combined procedures, mostly coronary artery bypass grafting in 170 (30.6%). Overall 30-days mortality was 5.4% (n=30) and cumulative survival at 5-years was 72.3%. There were 23 (4.3%) permanent pacemaker implantations. During follow-up, 5 (0.9%) patients presented non-structural valve dysfunction (NSVD) and 4 (0.8%) underwent reoperation due to prosthesis endocarditis. At the first ambulatory evaluation transvalvular mean gradient and effective orifice area (EOA) were 10.9±4.1 mmHg and 2.0±0.5 cm2, respectively. Severe patient-prosthesis mismatch (PPM) was observed in 5 (1.1%) individuals and moderate in 52 (11.3%). Conclusions In a "real-world" clinical setting, our findings support the good overall mid-term haemodynamic and safety profile of the Trifecta bioprosthesis.
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Affiliation(s)
- Renata Raimundo
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Soraia Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Francisca Saraiva
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Rui J Cerqueira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Pedro Teixeira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Elson Salgueiro
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - André Lourenço
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal
| | - Mário J Amorim
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Jorge Almeida
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Paulo Pinho
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.,Serviço de Cirurgia Cardiotorácica, Centro Hospitalar de São João, Porto, Portugal
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6
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
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Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
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7
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Popma JJ, Reardon MJ, Khabbaz K, Harrison JK, Hughes GC, Kodali S, George I, Deeb GM, Chetcuti S, Kipperman R, Brown J, Qiao H, Slater J, Williams MR. Early Clinical Outcomes After Transcatheter Aortic Valve Replacement Using a Novel Self-Expanding Bioprosthesis in Patients With Severe Aortic Stenosis Who Are Suboptimal for Surgery: Results of the Evolut R U.S. Study. JACC Cardiovasc Interv 2017; 10:268-275. [PMID: 28183466 DOI: 10.1016/j.jcin.2016.08.050] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate this transcatheter aortic valve (TAV) bioprosthesis in patients who are poorly suitable for surgical aortic valve (AV) replacement. BACKGROUND A novel self-expandable TAV bioprosthesis was designed to provide a low-profile delivery system, conformable annular sealing, and the ability to resheath and reposition during deployment. METHODS The Evolut R U.S. study included 241 patients with severe aortic stenosis who were deemed to be at least high risk for surgery treated at 23 clinical sites in the United States. Clinical outcomes at 30 days were evaluated using Valve Academic Research Consortium-2 criteria. An independent echocardiography laboratory was used to evaluate hemodynamic outcomes. RESULTS Patients were elderly (83.3 ± 7.2 years of age) and had high surgical risk (Society of Thoracic Surgeons predicted risk of mortality of 7.4 ± 3.4%). The majority of patients (89.5%) were treated by iliofemoral access. Resheathing or recapturing was performed in 22.6% of patients; more than 1 valve was required in 3 patients (1.3%). The 30-day outcomes included all-cause mortality (2.5%), disabling stroke (3.3%), major vascular complications (7.5%), life-threatening or disabling bleeding (7.1%), and new permanent pacemaker (16.4%). AV hemodynamics were markedly improved at 30 days: the mean AV gradient was reduced from 48.2 ± 13.0 mm Hg to 7.8 ± 3.1 mm Hg (p < 0.001) and AV area increased from 0.6 ± 0.2 cm2 to 1.9 ± 0.5 cm2 (p < 0.001). Moderate residual paravalvular leak was identified in 5.3% of patients. CONCLUSIONS We conclude that this novel self-expanding TAV bioprosthesis is safe and effective for the treatment of patients with severe aortic stenosis who are suboptimal for surgery. (Medtronic CoreValve Evolut R U.S. Clinical Study; NCT02207569).
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Affiliation(s)
- Jeffrey J Popma
- Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery), Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Institute, Houston, Texas
| | - Kamal Khabbaz
- Departments of Internal Medicine (Cardiovascular Division) and Surgery (Cardiovascular Surgery), Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - J Kevin Harrison
- Cardiology Division in the Duke Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - G Chad Hughes
- Cardiology Division in the Duke Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Susheel Kodali
- Department of Surgery, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
| | - Isaac George
- Department of Surgery, Columbia University Medical Center-New York Presbyterian Hospital, New York, New York
| | - G Michael Deeb
- Department of Cardiac Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Stan Chetcuti
- Department of Cardiac Surgery, University of Michigan Health Systems, Ann Arbor, Michigan
| | - Robert Kipperman
- Department of Cardiology, Morristown Memorial Hospital, Morristown, New Jersey
| | - John Brown
- Department of Cardiology, Morristown Memorial Hospital, Morristown, New Jersey
| | - Hongyan Qiao
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | - James Slater
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
| | - Mathew R Williams
- Departments of Medicine (Cardiology) and Cardiothoracic Surgery, New York University Langone Medical Center, New York, New York
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8
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Little SH, Oh JK, Gillam L, Sengupta PP, Orsinelli DA, Cavalcante JL, Chang JD, Adams DH, Zorn GL, Pollak AW, Abdelmoneim SS, Reardon MJ, Qiao H, Popma JJ. Self-Expanding Transcatheter Aortic Valve Replacement Versus Surgical Valve Replacement in Patients at High Risk for Surgery. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003426. [DOI: 10.1161/circinterventions.115.003426] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 05/16/2016] [Indexed: 01/25/2023]
Abstract
Background—
The CoreValve US High-Risk Clinical Study compared clinical outcomes and serial echocardiographic findings in patients with severe aortic valve stenosis after transcatheter aortic valve replacement (TAVR) with a self-expanding bioprosthesis or surgical aortic valve replacement (SAVR).
Methods and Results—
Eligible patients were randomly assigned 1:1 to TAVR with a self-expanding bioprosthesis or SAVR (N=747). Echocardiograms were obtained at baseline, discharge, 30 days, 6 months, and 1 year after the procedure and were analyzed at a central core laboratory. Compared with SAVR patients (N=357), TAVR patients (N=390) had a lower mean aortic valve gradient, larger valve area, and less patient–prosthesis mismatch (all
P
<0.001), but more paravalvular regurgitation at discharge, which decreased at 1 year. SAVR patients experienced significant right ventricular systolic dysfunction at discharge and 1 month with normal right ventricular function at 1 year. One-year all-cause mortality was 14.2% for TAVR and 19.1% for SAVR patients. Preimplantation aortic regurgitation ≥mild was associated with reduced mortality hazard for both the TAVR (hazard ratio 0.48, 95% confidence interval 0.27–0.85;
P
=0.01) and the SAVR groups (hazard ratio 0.53, 95% confidence interval 0.32–0.87;
P
=0.01). Aortic regurgitation ≥mild after TAVR was associated with increased risk for all-cause mortality (hazard ratio 1.95, 95% confidence interval 1.08–3.53;
P
=0.03).
Conclusions—
In patients with severe aortic stenosis at increased surgical risk, TAVR was associated with better systolic valve performance, similar left ventricular remodeling, more paravalvular regurgitation, and less right ventricular systolic dysfunction compared with SAVR. Despite an overall mortality reduction for the TAVR group, ≥mild aortic valve regurgitation after TAVR was associated with an increased mortality hazard.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01240902.
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Affiliation(s)
- Stephen H. Little
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Jae K. Oh
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Linda Gillam
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Partho P. Sengupta
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - David A. Orsinelli
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - João L. Cavalcante
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - James D. Chang
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - David H. Adams
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - George L. Zorn
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Amy W. Pollak
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Sahar S. Abdelmoneim
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Michael J. Reardon
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Hongyan Qiao
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
| | - Jeffrey J. Popma
- From the Departments of Cardiology (S.H.L.) and Cardiac Surgery (M.J.R.), Houston Methodist DeBakey Heart & Vascular Center, TX; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (J.K.O., S.S.A.), and Jacksonville, FL (A.W.P.); Department of Cardiovascular Medicine, Morristown Medical Center, NJ (L.G.); Departments of Cardiology (P.P.S.) and Cardiovascular Surgery (D.H.A.), Mount Sinai Medical Center, NY; Department of Cardiac Surgery, The Ohio State University, Columbus (D.A.O
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Naoum C, Blanke P, Dvir D, Pibarot P, Humphries K, Webb J, Leipsic J. Clinical Outcomes and Imaging Findings in Women Undergoing TAVR. JACC Cardiovasc Imaging 2016; 9:483-93. [DOI: 10.1016/j.jcmg.2016.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 02/12/2016] [Accepted: 02/18/2016] [Indexed: 01/09/2023]
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