Nirat Beohar1, Ajay J Kirtane2, Eugene Blackstone3, Ron Waksman4, David Holmes5, Sa'ar Minha4, Oluseun Alli6, Rakesh M Suri3, Lars G Svensson3, Martin Leon2, Susheel Kodali2. 1. Columbia University, Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida. Electronic address: Nirat.Beohar@msmc.com. 2. Department of Medicine, Columbia University Medical Center/New York Presbyterian Hospital, New York, New York. 3. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 4. Division of Cardiology, Medstar Washington Hospital Center, Washington, DC. 5. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. 6. Division of Cardiovascular Disease, University of Alabama-Birmingham, Birmingham, Alabama.
Abstract
OBJECTIVES: The aim of this study was to examine trends in the rates of complications and outcomes of patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR). BACKGROUND: It is unknown whether an evolution of case selection or accrual of case experience over time has resulted in a change in the rates of complications and outcomes of patients undergoing TF-TAVR. METHODS: TF-TAVR patients enrolled in the PARTNER (Placement of AoRTic TraNscathetER Valve Trial) nonrandomized continued access registry (N = 1,063, enrolled March 2011 to January 2012 after completion of the randomized trial) were divided into tertiles (T1 through T3) based on enrollment date. Patient characteristics and rates of adverse events were compared over time. RESULTS: There were no significant differences in sex, New York Heart Association functional classes III/IV, diabetes, coronary artery disease, previous revascularization, pulmonary hypertension, renal disease, or liver disease. There was an increase in mean age, but a decrease in porcelain aorta, chronic obstructive pulmonary disease (including oxygen-dependent chronic obstructive pulmonary disease), previous chest wall radiation, and a slight decrease in the median Society of Thoracic Surgeons Predicted Risk of Mortality score. There was a significant decline in the frequency of patients deemed "inoperable" (cohort B) and in need for post-dilation. Percutaneous access increased significantly. There were no differences in post-procedural stroke, major bleeding, major vascular complications, or the need for aortic valve reintervention over time. The incidence of moderate/severe paravalvular regurgitation declined significantly as did all-cause mortality at 1 and 2 years. CONCLUSIONS: A significant reduction in the incidence of moderate/severe paravalvular regurgitation as well as longer term all-cause mortality was observed over time. The cause of these reductions was likely multifactorial, including improved case selection and procedural techniques and increased site experience. (THE PARTNER TRIAL [Placement of AoRTic TraNscathetER Valve Trial]; NCT00530894).
OBJECTIVES: The aim of this study was to examine trends in the rates of complications and outcomes of patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR). BACKGROUND: It is unknown whether an evolution of case selection or accrual of case experience over time has resulted in a change in the rates of complications and outcomes of patients undergoing TF-TAVR. METHODS: TF-TAVR patients enrolled in the PARTNER (Placement of AoRTic TraNscathetER Valve Trial) nonrandomized continued access registry (N = 1,063, enrolled March 2011 to January 2012 after completion of the randomized trial) were divided into tertiles (T1 through T3) based on enrollment date. Patient characteristics and rates of adverse events were compared over time. RESULTS: There were no significant differences in sex, New York Heart Association functional classes III/IV, diabetes, coronary artery disease, previous revascularization, pulmonary hypertension, renal disease, or liver disease. There was an increase in mean age, but a decrease in porcelain aorta, chronic obstructive pulmonary disease (including oxygen-dependent chronic obstructive pulmonary disease), previous chest wall radiation, and a slight decrease in the median Society of Thoracic Surgeons Predicted Risk of Mortality score. There was a significant decline in the frequency of patients deemed "inoperable" (cohort B) and in need for post-dilation. Percutaneous access increased significantly. There were no differences in post-procedural stroke, major bleeding, major vascular complications, or the need for aortic valve reintervention over time. The incidence of moderate/severe paravalvular regurgitation declined significantly as did all-cause mortality at 1 and 2 years. CONCLUSIONS: A significant reduction in the incidence of moderate/severe paravalvular regurgitation as well as longer term all-cause mortality was observed over time. The cause of these reductions was likely multifactorial, including improved case selection and procedural techniques and increased site experience. (THE PARTNER TRIAL [Placement of AoRTic TraNscathetER Valve Trial]; NCT00530894).
Authors: Björn Redfors; Brendan M Watson; Thomas McAndrew; Emilie Palisaitis; Dominic P Francese; Mehdi Razavi; Jordan Safirstein; Roxana Mehran; Ajay J Kirtane; Philippe Généreux Journal: JAMA Cardiol Date: 2017-07-01 Impact factor: 14.676
Authors: Serban Mihai Balanescu; Dinu Valentin Balanescu; Teodora Donisan; Eric H Yang; Nicolas Palaskas; Juan Lopez-Mattei; Saamir Hassan; Peter Kim; Mehmet Cilingiroglu; Konstantinos Marmagkiolis; Biswajit Kar; Cezar Iliescu Journal: Curr Cardiol Rep Date: 2019-07-08 Impact factor: 2.931
Authors: Sahil Khera; Dhaval Kolte; Tanush Gupta; Andrew Goldsweig; Poonam Velagapudi; Ankur Kalra; Gilbert H L Tang; Wilbert S Aronow; Gregg C Fonarow; Deepak L Bhatt; Herbert D Aronow; Neal S Kleiman; Michael Reardon; Paul C Gordon; Barry Sharaf; J Dawn Abbott Journal: JAMA Cardiol Date: 2017-07-01 Impact factor: 14.676
Authors: Arash Salemi; Andrea De Micheli; Abdullah Aftab; Adham Elmously; Regis Chang; S Chiu Wong; Berhane M Worku Journal: Interact Cardiovasc Thorac Surg Date: 2018-12-01
Authors: Jason R Cuomo; Sean P Javaheri; Gyanendra K Sharma; Deepak Kapoor; Adam E Berman; Neal L Weintraub Journal: Heart Date: 2018-05-15 Impact factor: 5.994
Authors: Wayne Batchelor; Krishna Patel; Julian Hurt; James Totten; Penny Burroughs; Ginny Smith; Mig Cuervo; Lakerria Davis; Abdulla A Damluji; Kelly Epps; Matthew Sherwood; Scott Barnett; Nadim Geloo; Shahram Yazdani; Eric Sarin; Liam Ryan; Thomas Noel Journal: Cardiovasc Revasc Med Date: 2020-01-15