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Bezzeccheri A, Poletti E, Vermeersch P, Veulemans V, Piuhola J, Kerkelä S, Lehtola H, De Backer O, Quagliana A, Mammone C, Ribichini F, Prihadi E, Scott B, Zivelonghi C, Verheye S, Agostoni P. Prosthesis Infolding Incidence and Short-Term Outcomes in Transcatheter Aortic Valve Implantation Using Evolut Self-Expandable Device: A Multicenter Study. Am J Cardiol 2024:S0002-9149(24)00263-7. [PMID: 38636623 DOI: 10.1016/j.amjcard.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/03/2024] [Accepted: 04/13/2024] [Indexed: 04/20/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment strategy in aortic valve disease. Infolding, as a nonuniform expansion of the prosthesis leading to introflection of part of the device circumference, is a complication specific to self-expandable prostheses. The aim of the study is to determine incidence, predictors, treatment strategy, and outcomes of infolding during Medtronic Evolut TAVI. Between January 2018 and March 2022, all patients treated with Evolut TAVI were included in a multicenter observational retrospective study. According to the occurrence of infolding, the enrolled cohort was divided into 2 groups; periprocedural characteristics and 30-day outcomes were compared. A total of 1,470 patients were included; 23 infolding cases (1.6%) were detected. Preprocedural imaging showed larger aortic anatomy and greater calcium burden in the infolding group. Infolding occurred mostly with Evolut Pro+ and size 34 mm and was diagnosed before full prosthesis release in 78.3%. The rate of moderate-to-severe paravalvular regurgitation was higher in the infolding group (21.7% vs 1.9%, p <0.001). Short-term follow-up showed greater all-cause and cardiovascular mortality (respectively, 4.3% vs 0.7% and 4.3% vs 0.6%, p <0.05) and higher rate of pacemaker implantation (33.3% vs 15.7%, p = 0.042) in case of infolding. High right cusp calcium score and resheathing maneuvers were independent predictors of infolding. In conclusion, prosthesis infolding is a TAVI complication burdened by worse cardiovascular outcomes. Prompt intraprocedural infolding diagnosis is pivotal, especially in case of great native valve calcium burden and resheathing maneuvers, to safely overcome this complication by prosthesis recapture or postdilation.
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Affiliation(s)
- Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium; Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Enrico Poletti
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-Universität, Dusseldorf, Germany
| | - Jarkko Piuhola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Seija Kerkelä
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Heidi Lehtola
- Department of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Ole De Backer
- The Heart Center, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Concetta Mammone
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Flavio Ribichini
- Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Edgard Prihadi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Fischer J, Steffen J, Arlart T, Haum M, Gschwendtner S, Doldi PM, Rizas K, Theiss H, Braun D, Orban M, Peterß S, Hausleiter J, Massberg S, Deseive S. Concomitant percutaneous coronary intervention in patients undergoing transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:186-193. [PMID: 38140761 DOI: 10.1002/ccd.30927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Patients undergoing transcatheter aortic valve implantation (TAVI) frequently have coronary artery disease requiring percutaneous coronary intervention (PCI). Usually, PCI and TAVI are performed in two separate procedures and current studies are investigating potential benefits regarding the order. However, the two interventions may also be performed simultaneously, thereby limiting the risk associated with repeated vascular access. Data evaluating benefit and harm of concomitant procedures are scarce. AIMS Therefore, this study aimed to evaluate concomitant PCI (coPCI) in TAVI patients regarding Valve Academic Research Consortium 3 (VARC-3) endpoints and long-term mortality. METHODS A total of 2233 consecutive TAVI patients from the EVERY-VALVE registry were analyzed according to the VARC-3 endpoint definitions. A total of 274 patients had undergone TAVI and concomitant PCI (coPCI group). They were compared to 226 TAVI patients who had received PCI within 60 days before TAVI in a stepwise approach (swPCI group) and to the remaining 1733 TAVI patients who had not undergone PCI recently (noPCI group). RESULTS Overall median age was 81.4 years, median Society of Thoracic Surgeons score was 4.0%. Patients in the coPCI and in the swPCI group were predominantly male with reduced left-ventricular ejection fraction. Rates of VARC-3 composite endpoints technical success and 30-day device success were comparable between all three groups. Mortality rates at 3 years after TAVI were similar (coPCI, 34.2% vs. swPCI, 31.9% vs. noPCI, 34.0% p = 0.84). CONCLUSIONS coPCI during TAVI seems comparable in a retrospective analysis. Compared to a stepwise approach, it has similar rates of composite endpoints technical success and device success as well as long-term mortality.
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Affiliation(s)
- Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Tobias Arlart
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sarah Gschwendtner
- Zentrale Notaufnahme und Aufnahmestation, Campus Benjamin Franklin (CBF), Charité Universitätsmedizin, Berlin, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Sven Peterß
- Department of Heart Surgery, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
- Munich Heart Alliance, German Centre for Cardiovascular Research (DZHK), Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, Ludwig-Maximilians-Universität (LMU), Munich, Germany
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Savvoulidis P, Nadir AM, Mechery A, Lawton E, Khan K, Maqableh GM, Raja W, Wong CW, Radhakrishnan A, Doshi SN. Routine postaccess-closure angiography to detect vascular complications following transfemoral TAVR. Catheter Cardiovasc Interv 2023; 102:1311-1316. [PMID: 37890001 DOI: 10.1002/ccd.30894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/03/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Vascular complications following transfemoral TAVR are associated with increased morbidity and mortality. Measures that may mitigate this risk are important. AIM To evaluate the utility of routine, access-vessel angiography post sheath-removal in the detection and management of complications in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS This was a retrospective study of 512 consecutive patients who underwent transfemoral TAVR with routine post access-closure angiography from the radial artery. Rates of mild angiographically evident bleeding, bleeding requiring surgery/interventional-radiology, ischemia, 90-day access-site-related events, and major and minor vascular complications using Valve Academic Research Consortium 3 definitions were recorded. RESULTS Of 512 patients, digital subtraction angiography (DSA) was undertaken via the radial artery in 467 patients (91%). In the remaining patients (9%) DSA was either not attempted, due to concerns regarding kidney disease and contrast volume, or failed due to anatomical factors (aortic tortuosity/calcification). Significant chronic kidney disease was present at baseline in 72.4% of this cohort (stages III-IV or dialysis). Ninety-four percent of cases underwent TAVR using a balloon-expandable platform. Mild iliofemoral extravasation was observed in 7.7% of the DSA cases. These cases were managed by manual compression with none requiring any vascular intervention subsequently. Valve Academic Research Consortium 3 major and minor access-site-related complications were observed in 0.4% and 12.2%, respectively. Access-site-related bleeding and ischemic events requiring interventional-radiology or vascular-surgery were observed in 0.9% and 1.7% of the DSA cases, respectively. No new renal replacement therapy was needed in any of the DSA cases. Discharge to 90-day access-related complications was 0.8%. CONCLUSIONS Routine post access-closure angiography is feasible via the radial artery in patients undergoing transfemoral TAVR and appears safe. It facilitates early identification of complications and mitigates risk by enabling prompt action to be taken. Larger studies are needed to confirm these findings.
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Affiliation(s)
| | - Adnan M Nadir
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Anthony Mechery
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Ewa Lawton
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Kumail Khan
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Ghaith M Maqableh
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Cardiology Department, Faculty of Medicine, Al Balqa Applied University, Amman, Jordan
| | - Waseem Raja
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | - Chun Wai Wong
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
| | | | - Sagar N Doshi
- Department of Cardiology, Queen Elizabeth University Hospital, Birmingham, UK
- Institute for Cardiovascular Sciences, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
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Yildirim A, Genc O, Pacaci E, Sen O, Kurt IH. Real-Life Performance and Clinical Outcomes of Portico Transcatheter Aortic Valve with FlexNav Delivery System: One-Year Data from a Single-Center Experience. J Clin Med 2023; 12:5373. [PMID: 37629415 PMCID: PMC10455755 DOI: 10.3390/jcm12165373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/13/2023] [Indexed: 08/27/2023] Open
Abstract
Significant progress has been made in both valves and delivery systems (DSs) for transcatheter aortic valve replacement (TAVR) procedures. We aimed to present one-year real-life data regarding TAVR procedures using Portico transcatheter heart valves (THVs) with new-generation, low-profile FlexNav DSs. This retrospective, single-center study enrolled 169 consecutive patients (mean age: 75.8 years, 68% females) with severe aortic stenosis undergoing TAVR with Portico THVs and FlexNav DSs between 2020 and 2021. We evaluated safety and efficacy outcomes, following the VARC-3 consensus, periprocedurally and at 30 days and 1 year. Procedural success was observed in 95.9% of cases, and no procedural mortality occurred. At 30 days, the rates of all-cause mortality, cardiovascular mortality, and neurological events were 4.7%, 3.6%, and 3.0%, respectively. Additionally, major vascular complications, acute kidney injury, and bleeding were recorded at rates of 11.2%, 14.8%, and 7.7%, respectively. The 1-year data showed all-cause mortality, cardiovascular mortality, and neurological event rates of 10.7%, 8.3%, and 7.7%, respectively. The moderate paravalvular leak and permanent pacemaker rates at 1 year were 2.6% and 12.2%, respectively. This real-life data provided evidence of positive outcomes and high technical success with Portico THVs and FlexNav DSs. Furthermore, we found low rates of mortality and neurological events, with satisfactory hemodynamic and functional results.
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Affiliation(s)
- Abdullah Yildirim
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Omer Genc
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, 34480 Istanbul, Turkey;
| | - Emre Pacaci
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Omer Sen
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
| | - Ibrahim Halil Kurt
- Department of Cardiology, Adana City Training & Research Hospital, University of Health Sciences, 01230 Adana, Turkey; (E.P.); (O.S.); (I.H.K.)
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Steffen J, Andreae D, Nabauer M, Reißig N, Doldi PM, Haum M, Orban M, Theiss H, Rizas K, Braun D, Peterß S, Hausleiter J, Massberg S, Deseive S. TAVI for patients with normal-flow low-gradient compared to high-gradient aortic stenosis. Int J Cardiol 2023; 371:299-304. [PMID: 36306951 DOI: 10.1016/j.ijcard.2022.10.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/15/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Normal-flow (stroke volume index, SVi >35 ml/m2) low-gradient (dPmean <40 mmHg) aortic stenosis (NFLG-AS) is subject of scientific debate. Guidelines fail to give conclusive treatment recommendations. We hypothesized that NFLG patients are heterogenous, containing a subgroup similar to high-gradient aortic stenosis patients (dPmean ≥40 mmHg, HG-AS) concerning characteristics and outcomes. METHODS 2326 patients undergoing transcatheter aortic valve replacement (TAVI) at our centre between 2013 and 2019 were analysed. 386 patients fulfilled criteria of NFLG-AS. Their median dPmean was 33 mmHg, which was used for grouping (204 patients with higher gradient NFLG-AS, 186 patients with lower gradient NFLG-AS). They were compared to 956 HG-AS patients. RESULTS Characteristics of lower gradient NFLG-AS patients differed from HG-AS patients in many aspects while higher gradient NFLG-AS and HG-AS patients were mostly similar, underscored by higher Society of Thoracic Surgeons scores in lower gradient NFLG-AS (lower gradient NFLG-AS, 3.9, HG-AS, 3.0, p = 0.03, higher gradient NFLG-AS, 3.0, p = 0.04). Procedural complications were comparable. Estimated 3-year all-cause mortality was higher in lower gradient NFLG-AS compared to HG-AS patients (hazard ratio 1.7, p < 0.01), whereas mortality of higher gradient NFLG-AS was similar to HG-AS patients (hazard ratio 1.2, p = 0.31). Cardiovascular mortality was highest among lower gradient NFLG-AS patients (21.6% vs. higher gradient NFLG-AS, 15.4%, vs. HG-AS, 11.1%, p < 0.01). CONCLUSIONS NFLG-AS patients are indeed heterogenous. NFLG-AS patients with higher gradients resemble HG-AS patients in clinical characteristics and outcomes and should not be treated differently. Lower gradient NFLG-AS patients have increased long-term mortality and the use of TAVI requires careful consideration.
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Bezzeccheri A, Vermeersch P, Verheye S, Wilgenhof A, Willemen Y, Vescovo GM, Scott B, Convens C, Zivelonghi C, Agostoni P. Trends and outcomes in transcatheter aortic valve implantation in Belgium: a 13-year single centre experience. Acta Cardiol 2022; 77:960-969. [PMID: 36326198 DOI: 10.1080/00015385.2022.2130444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has been adopted as an alternative to surgery in severe aortic stenosis treatment, even in low-intermediate risk. The aim of this study is to retrospectively report our single-centre 13-year TAVI experience with emphasis on learning curve, referral indication and trends in outcomes over time. METHODS We included 361 consecutive patients who underwent TAVI from January 2008 to December 2020, grouped according to similar per-year volume of procedures: G1 (2008-2014), G2 (2015-2017) and G3 (2018-2020). RESULTS The number of procedures increased (group size: 59 vs. 106 vs. 196). No major differences were observed in STS-PROM and EuroSCORE-II between groups, despite TAVI in patients with prior surgical revascularisation was mainly performed in G1. Trans-femoral approach raised from 80.8 to 93.4%, while the most common alternative access was trans-subclavian. The pre-dilation rate was higher in G1 with lower prosthesis post-dilation rate. The length of hospital stay decreased in time by 30%. At 30 days a reduction in all-cause mortality, vascular complications, bleedings and para-valvular leak combined with higher rate of permanent pacing were observed over the groups. At 1-year there was no difference in all-cause mortality but over 30% reduction in cardiovascular death (8.5 vs. 7.5 vs. 5.6%). CONCLUSIONS Favourable trends were observed across the groups, with an improvement in periprocedural outcomes and cardiovascular mortality at 1-year. These improvements could depend on increased expertise because mortality reduction was noted only after reaching a significant procedure volume. A trend towards lower risk patients selection was present in our cohort, as previously described worldwide.
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Affiliation(s)
- Andrea Bezzeccheri
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium.,Department of Experimental Medicine, University of Rome 'Tor Vergata', Rome, Italy
| | - Paul Vermeersch
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Stefan Verheye
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Adriaan Wilgenhof
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Yannick Willemen
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | | | - Benjamin Scott
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carl Convens
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Carlo Zivelonghi
- HartCentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
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Steffen J, Reißig N, Andreae D, Beckmann M, Haum M, Fischer J, Theiss H, Braun D, Orban M, Rizas K, Sadoni S, Näbauer M, Peterss S, Hausleiter J, Massberg S, Deseive S. TAVI in patients with low-flow low-gradient aortic stenosis-short-term and long-term outcomes. Clin Res Cardiol 2022; 111:1325-1335. [PMID: 35320407 DOI: 10.1007/s00392-022-02011-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The study objective was to characterize different groups of low-flow low-gradient (LFLG) aortic stenosis (AS) and determine short-term outcomes and long-term mortality according to Valve Academic Research Consortium-3 (VARC-3) endpoint definitions. BACKGROUND Characteristics and outcomes of patients with LFLG AS undergoing transcatheter aortic valve implantation (TAVI) are poorly understood. METHODS All patients undergoing TAVI at our center between 2013 and 2019 were screened. Patients were divided into three groups according to mean pressure gradient (dPmean), ejection fraction (LVEF), and stroke volume index (SVi): high gradient (HG) AS (dPmean ≥ 40 mmHg), classical LFLG (cLFLG) AS (dPmean < 40 mmHg, LVEF < 50%), and paradoxical LFLG (pLFLG) AS (dPmean < 40 mmHg, LVEF ≥ 50%, SVi ≤ 35 ml/m2). RESULTS We included 1776 patients (956 HG, 447 cLFLG, and 373 pLFLG patients). Most baseline characteristics differed significantly. Median Society of Thoracic Surgeons (STS) score was highest in cLFLG, followed by pLFLG and HG patients (5.0, 3.9 and 3.0, respectively, p < 0.01). Compared to HG patients, odds ratios for the short-term VARC-3 composite endpoints, technical failure (cLFLG, 0.76 [95% confidence interval, 0.40-1.36], pLFLG, 1.37 [0.79-2.31]) and device failure (cLFLG, 1.06 [0.74-1.49], pLFLG, 0.97 [0.66-1.41]) were similar, without relevant differences within LFLG patients. NYHA classes improved equally in all groups. Compared to HG, LFLG patients had a higher 3-year all-cause mortality (STS score-adjusted hazard ratios, cLFLG 2.16 [1.77-2.64], pLFLG 1.53 [1.22-193]), as well as cardiovascular mortality (cLFLG, 2.88 [2.15-3.84], pLFLG, 2.08 [1.50-2.87]). CONCLUSIONS While 3-year mortality remains high after TAVI in LFLG compared to HG patients, symptoms improve in all subsets after TAVI.
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Affiliation(s)
- Julius Steffen
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Nikolas Reißig
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - David Andreae
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Markus Beckmann
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Julius Fischer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Hans Theiss
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Konstantinos Rizas
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Sebastian Sadoni
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Sven Peterss
- Herzchirurgische Klinik und Poliklinik, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Munich, Munich, Germany
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, LMU Klinikum, LMU München, Marchioninistr. 15, 81377, Munich, Germany.
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