Francesco Saia1, Claudia Martinez2, Sameer Gafoor3, Vikas Singh2, Cristina Ciuca4, Ilona Hofmann3, Cinzia Marrozzini4, John Tan5, John Webb5, Horst Sievert3, Antonio Marzocchi4, William W O'Neill6. 1. Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. Electronic address: francescosaia@hotmail.com. 2. Cardiovascular Division, University of Miami Miller School of Medicine, Miami, Florida. 3. Cardiovascular Center Frankfurt, Frankfurt, Germany. 4. Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy. 5. Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. 6. Henry Ford Health System, Center for Structural Heart Disease, Detroit, Michigan.
Abstract
OBJECTIVES: This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). BACKGROUND: Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. METHODS: The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. RESULTS: Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes. CONCLUSIONS: Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.
OBJECTIVES: This study sought to evaluate acute and long-term outcomes of percutaneous paravalvular regurgitation (PVR) closure after transcatheter aortic valve replacement (TAVR). BACKGROUND: Severe symptomatic PVR is a predictor of all-cause mortality after TAVR. The current use of devices for transcatheter closure of PVR has been adapted from other indications without known long-term outcomes. METHODS: The study population consisted of a series of cases pooled together from an international multicenter experience. Patients underwent transcatheter implantation of a closure device for the treatment of clinically relevant PVR after TAVR with balloon-expandable or self-expandable prostheses. Procedural success was defined by successful deployment of a device with immediate reduction of PVR to a final grade ≤2 as assessed by echocardiography. RESULTS: Twenty-seven procedures were performed in 24 patients with clinically relevant PVR after the index TAVR procedure (54.2% Edwards Sapien [Edwards Lifesciences, Irvine, California], 45.8% CoreValve [Medtronic, Minneapolis, Minnesota]). The study population included 75% men with a mean age of 80.6 ± 7.1 years and mean Society of Thoracic Surgeon score of 6.6%. The most frequently used device was Amplatzer Vascular Plug (St. Jude Medical, St. Paul, Minnesota) in 80% of the cases. Overall, 88.9% (24 of 27) of the procedures were technically successful and the results assessed by echocardiography were durable. However, cumulative survival rates at 1, 6, and 12 months were 83.3%, 66.7%, and 61.5%. Most of the deaths (8 of 11) were due to noncardiac causes. CONCLUSIONS: Transcatheter closure of PVR after TAVR can be performed with a high procedural success rate; however, the long-term mortality remains high mainly due to noncardiac causes.
Authors: Enzo Lüsebrink; Antonia Kellnar; Clemens Scherer; Kathrin Krieg; Mathias Orban; Tobias Petzold; Sven Peterss; Stefan Kääb; Stefan Brunner; Daniel Braun; Christian Hagl; Jörg Hausleiter; Steffen Massberg; Martin Orban Journal: Clin Res Cardiol Date: 2021-05-09 Impact factor: 5.460
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Authors: Ratnasari Padang; Mahmoud Ali; Kevin L Greason; Christopher G Scott; Manasawee Indrabhinduwat; Charanjit S Rihal; Mackram F Eleid; Vuyisile T Nkomo; Patricia A Pellikka; Sorin V Pislaru Journal: BMJ Open Date: 2018-12-09 Impact factor: 2.692