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Zhou C, Xia Z, Song Y, Lian Z. Transcatheter versus surgical aortic valve replacement in patients with aortic regurgitation: A propensity-matched analysis. Heliyon 2023; 9:e16734. [PMID: 37303509 PMCID: PMC10248226 DOI: 10.1016/j.heliyon.2023.e16734] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
This study aimed to analyze in-hospital and early-to-interim outcomes of pure aortic regurgitation (AR) using transcatheter aortic valve replacement (TAVR) vs. surgical aortic valve replacement (SAVR). Background Few studies have discussed and compared the safety and short-term prognosis of TAVR and SAVR in pure AR patients. As such, we looked to the National Readmissions Database (NRD) for records between 2016 and 2019 in order to identify patients diagnosed with pure AR who underwent SAVR or TAVR. We used the propensity score matching to minimize disparities between two groups. We included 23,276 pure AR patients: 1983 (8.5%) who underwent TAVR and 21,293 (91.5%) who underwent SAVR. We found 1820 matched pairs using propensity score matching. In the matching cohort, TAVR was associated with a low risk of in-hospital mortality. Although TAVR had lower incidences of 30-day all-cause readmission (hazard ratio (HR):0.73, 95% confidence interval (CI): 0.61-0.87; P < 0.01) and 6-month all-cause readmission (HR: 0.81, 95% CI: 0.67-0.97; P = 0.03), while TAVR had high incidences of 30-day permanent pacemaker implantation incidence (HR: 3.54, 95% CI: 1.62-7.74; P < 0.01) and 6-month permanent pacemaker implantation incidence (HR: 4.12, 95% CI: 1.17-14.4; P = 0.03).In conclusion, TAVR and SAVR had similar risks of hospital death and lower rates of 30-day and 6-month all-cause and cardiovascular readmission. But TAVR had a higher risk of permanent pacemaker implantation than SAVR in AR patients, suggesting that TAVR can be performed safely in pure AR patients.
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Affiliation(s)
| | | | | | - Zhexun Lian
- Corresponding author. No 16 Jiangsu Road, Shinan District, Qingdao, Shandong Province, China.
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Delhomme C, Urena M, Zouaghi O, Campelo-Parada F, Ohlmann P, Rioufol G, Van Belle E, Pinaud F, Meneveau N, Staat P, Morel O, Derimay F, Vincent F, Rouleau F, Brochet E, Chong-Nguyen C, Himbert D. Transcatheter aortic valve implantation using the SAPIEN 3 valve to treat aortic regurgitation: The French multicentre S3AR study. Arch Cardiovasc Dis 2023; 116:98-105. [PMID: 36707263 DOI: 10.1016/j.acvd.2022.12.003] [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: 10/19/2022] [Revised: 12/07/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation. AIMS We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves. METHODS We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve. RESULTS A total of 37 patients (male sex, 73%) with a median age of 81years (interquartile range 69-85years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n=31) had dyspnoea New York Heart Association class≥III. The device success rate was 94.6% (n=35). At 30days, the all-cause mortality rate was 8.1% (n=3) and valve migration occurred in 10.8% of cases (n=4). Dyspnoea New York Heart Association class≤II was seen in 86.5% of patients (n=32), and all survivors had aortic regurgitation grade≤1. At 1-year follow-up, all-cause mortality was 16.2% (n=6), 89.7% (n=26/29) of survivors were in New York Heart Association class≤II and all had aortic regurgitation grade≤2. CONCLUSION Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement.
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Affiliation(s)
- Clémence Delhomme
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France.
| | - Marina Urena
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | | | | | | | - Gilles Rioufol
- Hôpital Cardiologique et Pneumologique Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Eric Van Belle
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Cœur Poumon, Cardiology, CHU Lille, 59000 Lille, France
| | - Frédéric Pinaud
- Service Médico-Chirurgical de Valvulopathies, University Hospital Angers, 49100 Angers, France
| | | | - Patrick Staat
- Medipôle Lyon-Villeurbanne, 69100 Villeurbanne, France
| | - Olivier Morel
- Strasbourg University Hospital, 67000 Strasbourg, France
| | - François Derimay
- Hôpital Cardiologique et Pneumologique Louis-Pradel, Hospices Civils de Lyon, 69500 Bron, France
| | - Flavien Vincent
- Department of Interventional Cardiology for Coronary, Valves and Structural Heart Diseases, Institut Cœur Poumon, Cardiology, CHU Lille, 59000 Lille, France
| | - Frédéric Rouleau
- Service Médico-Chirurgical de Valvulopathies, University Hospital Angers, 49100 Angers, France
| | - Eric Brochet
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
| | - Dominique Himbert
- Department of Cardiology, Bichat Hospital, AP-HP, Inserm U 1148, University of Paris, 75018 Paris, France
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Forcillo J. Less invasive treatments for pure aortic insufficiency: Are we there yet? J Card Surg 2022; 37:893-894. [DOI: 10.1111/jocs.16237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Jessica Forcillo
- Cardiac Surgery Department Centre Hospitalier de l'Université de Montréal Université de Montréal Montreal Québec Canada
- Centre Hospitalier de l'Université de Montréal Research Centre Université de Montréal Montreal Québec Canada
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