Susheel Kodali1, Philippe Pibarot2, Pamela S Douglas3, Mathew Williams4, Ke Xu5, Vinod Thourani6, Charanjit S Rihal7, Alan Zajarias8, Darshan Doshi4, Michael Davidson9, E Murat Tuzcu10, William Stewart10, Neil J Weissman11, Lars Svensson10, Kevin Greason7, Hersh Maniar8, Michael Mack12, Saif Anwaruddin13, Martin B Leon4, Rebecca T Hahn4. 1. Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA sk2427@columbia.edu. 2. Laval University, Quebec, QC, USA. 3. Duke Clinical Research Institute, Durham, NC, USA. 4. Herbert and Sandi Feinberg Interventional Cardiology, Heart Valve Center at Columbia University Medical Center/New York-Presbyterian Hospital, 177 Fort Washington Avenue, New York, NY 10032, USA. 5. Cardiovascular Research Foundation, New York, NY, USA. 6. Emory University School of Medicine, Atlanta, GA, USA. 7. Mayo Clinic, Rochester, MN, USA. 8. Washington University School of Medicine, Saint Louis, MO, USA. 9. Brigham and Women's Hospital, Boston, MA, USA. 10. Cleveland Clinic, Cleveland, OH, USA. 11. Medstar Health Research Institute, Washington, DC, USA. 12. Baylor Healthcare System, Plano, TX, USA. 13. Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Abstract
AIM: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains uncertain. In this analysis, we sought to evaluate the impact of varying degrees of PVR on both mortality and changes in ventricular geometry and function. METHODS AND RESULTS: Clinical and echocardiographic outcomes of patients who underwent TAVR from the randomized cohorts and continued access registries in the PARTNER trial were analysed after stratifying by severity of post-implant PVR, which was graded as none/trace in 52.9% (n = 1288), mild in 38.0% (n = 925), and moderate/severe in 9.1% (n = 221). There were significant differences in baseline clinical and echocardiographic characteristics. After TAVR, all the patients demonstrated increase in left ventricular (LV) function and reduction in the LV mass index, although the magnitude of mass regression was lower in the moderate/severe PVR group. The 30-day mortality (3.1 vs. 3.4 vs. 4.5%, P = 0.56) and stroke (3.4 vs. 3.7 vs. 2.3%, P = 0.59) were similar in all groups (none/trace, mild, and moderate/severe). At 1 year, there was increased all-cause mortality (15.9 vs. 22.2 vs. 35.1%, P < 0.0001), cardiac mortality (6.1 vs. 7.4% vs. 16.3%, P < 0.0001) and re-hospitalization (14.4 vs. 23.0 vs. 31.3%, P < 0.0001) with worsening PVR. A multivariable analysis indicated that the presence of moderate/severe PVR (HR: 2.18, 95% CI: 1.57-3.02, P < 0.0001) or mild PVR (HR: 1.37, 95% CI: 1.14-1.90, P = 0.012) was associated with higher late mortality. CONCLUSION: Differences in baseline characteristics in patients with increasing severities of PVR may increase the risk of this complication. Despite these differences, multivariable analysis demonstrated that both mild and moderate/severe PVR predicted higher 1-year mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIM: The impact of paravalvular regurgitation (PVR) following transcatheter aortic valve replacement (TAVR) remains uncertain. In this analysis, we sought to evaluate the impact of varying degrees of PVR on both mortality and changes in ventricular geometry and function. METHODS AND RESULTS: Clinical and echocardiographic outcomes of patients who underwent TAVR from the randomized cohorts and continued access registries in the PARTNER trial were analysed after stratifying by severity of post-implant PVR, which was graded as none/trace in 52.9% (n = 1288), mild in 38.0% (n = 925), and moderate/severe in 9.1% (n = 221). There were significant differences in baseline clinical and echocardiographic characteristics. After TAVR, all the patients demonstrated increase in left ventricular (LV) function and reduction in the LV mass index, although the magnitude of mass regression was lower in the moderate/severe PVR group. The 30-day mortality (3.1 vs. 3.4 vs. 4.5%, P = 0.56) and stroke (3.4 vs. 3.7 vs. 2.3%, P = 0.59) were similar in all groups (none/trace, mild, and moderate/severe). At 1 year, there was increased all-cause mortality (15.9 vs. 22.2 vs. 35.1%, P < 0.0001), cardiac mortality (6.1 vs. 7.4% vs. 16.3%, P < 0.0001) and re-hospitalization (14.4 vs. 23.0 vs. 31.3%, P < 0.0001) with worsening PVR. A multivariable analysis indicated that the presence of moderate/severe PVR (HR: 2.18, 95% CI: 1.57-3.02, P < 0.0001) or mild PVR (HR: 1.37, 95% CI: 1.14-1.90, P = 0.012) was associated with higher late mortality. CONCLUSION: Differences in baseline characteristics in patients with increasing severities of PVR may increase the risk of this complication. Despite these differences, multivariable analysis demonstrated that both mild and moderate/severe PVR predicted higher 1-year mortality. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Peter E Umukoro; Paul Yeung-Lai-Wah; Sunil Pathak; Sabri Elkhidir; Deepa Soodi; Brooke Delgoffe; Richard Berg; Kelley P Anderson; Romel J Garcia-Montilla Journal: Clin Med Res Date: 2020-10-14
Authors: Nadja Wystub; Laura Bäz; Sven Möbius-Winkler; Tudor C Pörner; Björn Goebel; Ali Hamadanchi; Torsten Doenst; Julia Grimm; Lukas Lehmkuhl; Ulf Teichgräber; P Christian Schulze; Marcus Franz Journal: Clin Res Cardiol Date: 2019-04-10 Impact factor: 5.460
Authors: Nicholas Chew; Jimmy Kim Fatt Hon; Wei Luen James Yip; Siew Pang Chan; Kian-Keong Poh; William Kok-Fai Kong; Kristine Leok Kheng Teoh; Tiong Cheng Yeo; Huay Cheem Tan; Edgar Lik Wui Tay Journal: Singapore Med J Date: 2016-08-12 Impact factor: 1.858
Authors: Susheel Kodali; Vinod H Thourani; Jonathon White; S Chris Malaisrie; Scott Lim; Kevin L Greason; Mathew Williams; Mayra Guerrero; Andrew C Eisenhauer; Samir Kapadia; Dean J Kereiakes; Howard C Herrmann; Vasilis Babaliaros; Wilson Y Szeto; Rebecca T Hahn; Philippe Pibarot; Neil J Weissman; Jonathon Leipsic; Philipp Blanke; Brian K Whisenant; Rakesh M Suri; Raj R Makkar; Girma M Ayele; Lars G Svensson; John G Webb; Michael J Mack; Craig R Smith; Martin B Leon Journal: Eur Heart J Date: 2016-03-31 Impact factor: 29.983