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van Bergeijk KH, Wykrzykowska JJ, van Mieghem NM, Windecker S, Sondergaard L, Gada H, Li S, Hanson T, Deeb GM, Voors AA, Reardon MJ. Predicting 5-Year Clinical Outcomes After Transcatheter or Surgical Aortic Valve Replacement (a Risk Score from the SURTAVI Trial). Am J Cardiol 2023; 200:78-86. [PMID: 37307783 DOI: 10.1016/j.amjcard.2023.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
Risk prediction scores for long-term outcomes after transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are lacking. This study aimed to develop preprocedural risk scores for 5-year clinical outcomes after TAVI or SAVR. This analysis included 1,660 patients at an intermediate surgical risk with severe aortic stenosis randomly assigned to TAVI (n = 864) or SAVR (n = 796) from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. The primary end point was a composite of all-cause mortality or disabling stroke at 5 years. The secondary end point was a composite of cardiovascular mortality or hospitalizations for valve disease or worsening heart failure at 5 years. Preprocedural multivariable predictors of clinical outcomes were used to calculate a simple risk score for both procedures. At 5 years, the primary end point occurred in 31.3% of the patients with TAVI and 30.8% of the patients with SAVR. Preprocedural predictors differed between TAVI and SAVR. Baseline anticoagulant use was a common predictor for events in both procedures, whereas male sex and a left ventricular ejection fraction <60% were significant predictors for events in patients with TAVI and SAVR, respectively. A total of 4 simple scoring systems were created based on these multivariable predictors. The C-statistics of all models were modest but performed better than the contemporary risk scores. In conclusion, preprocedural predictors of events differ between TAVI and SAVR, necessitating separate risk models. Despite the modest predictive value of the SURTAVI risk scores, they appeared superior to other contemporary scores. Further research is needed to strengthen and validate our risk scores, possibly by including biomarker and echocardiographic parameters.
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Affiliation(s)
- Kees H van Bergeijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joanna J Wykrzykowska
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, Pittsburgh, Pennsylvania
| | - Shuzhen Li
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | - Tim Hanson
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Adriaan A Voors
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Avci Y, Demir AR, Bulut U, Demirci G, Karakurt ST, Sancar KM, Aktemur T, Uygur B, Ersoy B, Erturk M. Novel markers of ventricular repolarization are associated with mortality in patients undergoing surgical aortic valve replacement for severe aortic stenosis. J Card Surg 2021; 36:4591-4596. [PMID: 34628679 DOI: 10.1111/jocs.16063] [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: 08/03/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Aortic stenosis (AS) is the most common degenerative valvular heart disease that can affect left ventricular functions. Tp-e interval and Tp-e/QT ratio is a novel repolarization marker which is associated with adverse cardiovascular events in several cardiovascular diseases. In our study, our aim is to investigate the prognostic effect of Tp-e interval, Tp-e/QT and Tp-e/QTc ratios on mortality in patients who underwent successful surgical aortic valve replacement (AVR). METHODS A total of three hundred seventy-five patients undergoing successful surgical AVR were included in this study. Then, patients were divided into two groups according to mortality as group 1 without mortality (342 patients) and group 2 with mortality (33 patients). Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios were calculated for both groups. RESULTS Tp-e interval (71 (63.7-77); 86 (84-88), p < .001), Tp-e/QT ratio (0.19 (0.17-0.20); 0.23 (0.22-0.23), p < .001) and Tp-e/QTc ratio (0.17 ± 0.02; 0.21 ± 0.01, p < .001) were higher in group 2 compared to group 1. In multivariate logistic regression analyses Tp-e interval (odds ratio [OR]: 1.315, 95% confidence interval [CI]: 1.203-1.437, p < .001), Tp-e/QT ratio (OR: 7.334, 95% CI: 3.274-1.643, p < .001) and Tp-e/QTc ratio (OR: 2.567, 95% CI: 4.106-1.605, p < .001) were found to be independent predictors of mortality. Additionally, a Kaplan-Meier survival analysis also revealed that long term survival was found to be significantly decreased in patients with higher Tp-e/QT ratio (Log-Rank p < .001) and Tp-e/QTc ratio (Log-Rank p < .001). CONCLUSION Tp-e interval, Tp-e dispersion, Tp-e/QT, and Tp-e/QTc ratios are associated with worse prognosis after surgical AVR in patients with severe AS. All of them are also independent predictors of mortality.
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Affiliation(s)
- Yalcin Avci
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali R Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Umit Bulut
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gökhan Demirci
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Seda T Karakurt
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kadriye M Sancar
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Tugba Aktemur
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Begüm Uygur
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Ersoy
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Rahman F, Resar JR. TAVI Beyond 3 Years: Durability and Predictors for Survival. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:417-425. [PMID: 34182824 DOI: 10.1177/15569845211017558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of transcatheter aortic valve implantation (TAVI) has greatly increased over the past 2 decades and now has overtaken surgical aortic valve replacement. We have limited data regarding the long-term durability of TAVI and the predictors of survival. Calcification, inflammation, fibrous tissue deposition, and mechanical stress are important in the structural deterioration of surgical bioprosthetic valves and likely contribute to TAVI durability. However, TAVI has several differences to surgical valve replacement such as valve preparation, valve to native anatomy interaction, and valve sizing which all likely contribute to durability and long-term survival. Most procedures have been performed on older patients and therefore long-term follow-up studies have noted mortality of approximately 50% at 5 years and 75% by 7 years. Current data are limited by the high mortality of patients who have received TAVI often as a result of age, frailty, and other competing comorbidities. TAVI as compared with surgical valve replacement is associated with several differences including higher conduction abnormalities (i.e., need for pacemakers) and paravalvular leak, both of which may affect long-term morbidity and mortality. In this review, we discuss the current status of our knowledge and identify areas that require further investigation.
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Affiliation(s)
- Faisal Rahman
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jon R Resar
- 1501 Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Reddy YNV, Nishimura RA. The Changing Landscape of Treatment for Aortic Stenosis: Continuing to Push the Boundaries. Mayo Clin Proc 2020; 95:9-11. [PMID: 31902432 DOI: 10.1016/j.mayocp.2019.11.008] [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] [Received: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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