Melissa A Daubert1, Neil J Weissman2, Rebecca T Hahn3, Philippe Pibarot4, Rupa Parvataneni5, Michael J Mack6, Lars G Svensson7, Deepika Gopal6, Samir Kapadia7, Robert J Siegel8, Susheel K Kodali3, Wilson Y Szeto9, Raj Makkar8, Martin B Leon3, Pamela S Douglas10. 1. Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina. Electronic address: melissa.daubert@duke.edu. 2. MedStar Health Research Institute, Washington, DC. 3. Columbia University Medical Center, New York, New York. 4. Quebec Heart and Lung Institute, Quebec, Ontario, Canada. 5. Cardiovascular Research Foundation, New York, New York. 6. Baylor Scott & White Healthcare, Plano, Texas. 7. Cleveland Clinic, Cleveland, Ohio. 8. Cedars-Sinai Medical Center, Los Angeles, California. 9. University of Pennsylvania Medical Center, Philadelphia, Pennsylvania. 10. Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
Abstract
OBJECTIVES: The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis. BACKGROUND: The long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years. METHODS: All patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar's analyses. RESULTS: There were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35). The AV mean gradient also remained stable: 11.5 ± 5.4 mm Hg at FPI to 11.0 ± 6.3 mm Hg at 5 years (p = 0.41). In contrast, the peak AV and LV outflow tract velocities decreased (p = 0.03 and p = 0.008, respectively), as did in-stent velocity (p = 0.015). Correspondingly, the TAVR Doppler velocity index was unchanged (p = 0.07). Among TAVR patients, there was no change in total AR (p = 0.40), transvalvular AR (p = 0.37), or paravalvular AR (p = 0.26). Stroke volume index and cardiac index remained stable (p = 0.16 and p = 0.25, respectively). However, there was a significant regression of LV mass index (p < 0.0001). The longitudinal evaluation among SAVR patients revealed similar trends. There was a low rate of adverse events among TAVR and SAVR patients alive at 5 years. CONCLUSIONS: Longitudinal assessment of the PARTNER I trial (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVR and SAVR in patients alive at 5 years. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
OBJECTIVES: The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis. BACKGROUND: The long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years. METHODS: All patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar's analyses. RESULTS: There were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35). The AV mean gradient also remained stable: 11.5 ± 5.4 mm Hg at FPI to 11.0 ± 6.3 mm Hg at 5 years (p = 0.41). In contrast, the peak AV and LV outflow tract velocities decreased (p = 0.03 and p = 0.008, respectively), as did in-stent velocity (p = 0.015). Correspondingly, the TAVR Doppler velocity index was unchanged (p = 0.07). Among TAVR patients, there was no change in total AR (p = 0.40), transvalvular AR (p = 0.37), or paravalvular AR (p = 0.26). Stroke volume index and cardiac index remained stable (p = 0.16 and p = 0.25, respectively). However, there was a significant regression of LV mass index (p < 0.0001). The longitudinal evaluation among SAVR patients revealed similar trends. There was a low rate of adverse events among TAVR and SAVR patients alive at 5 years. CONCLUSIONS: Longitudinal assessment of the PARTNER I trial (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVR and SAVR in patients alive at 5 years. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
Authors: J Hunter Mehaffey; Nathan S Haywood; Robert B Hawkins; John A Kern; Nicholas R Teman; Irving L Kron; Leora T Yarboro; Gorav Ailawadi Journal: Ann Thorac Surg Date: 2018-03-22 Impact factor: 4.330
Authors: Giuseppe Tarantini; Paola A M Purita; Augusto D'Onofrio; Chiara Fraccaro; Anna Chiara Frigo; Gianpiero D'Amico; Luca Nai Fovino; Marta Martin; Francesco Cardaioli; Mostafa R A Badawy; Massimo Napodano; Gino Gerosa; Sabino Iliceto Journal: Ann Cardiothorac Surg Date: 2017-09
Authors: Pamela S Douglas; Martin B Leon; Michael J Mack; Lars G Svensson; John G Webb; Rebecca T Hahn; Philippe Pibarot; Neil J Weissman; D Craig Miller; Samir Kapadia; Howard C Herrmann; Susheel K Kodali; Raj R Makkar; Vinod H Thourani; Stamatios Lerakis; Ashley M Lowry; Jeevanantham Rajeswaran; Matthew T Finn; Maria C Alu; Craig R Smith; Eugene H Blackstone Journal: JAMA Cardiol Date: 2017-11-01 Impact factor: 14.676