Robert B Hawkins1, Jared P Beller1, J Hunter Mehaffey1, Eric J Charles1, Mohammed A Quader2, Jeffrey B Rich3, Andy C Kiser4, Mark Joseph5, Alan M Speir6, John A Kern1, Gorav Ailawadi7. 1. Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. 2. Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, Virginia. 3. Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio. 4. Division of Cardiac Surgery, Eastern Carolina University, Greenville, North Carolina. 5. Division of Cardiovascular and Thoracic Surgery, Carilion Clinic/Virginia Tech Carilion School of Medicine, Roanoke, Virginia. 6. INOVA Heart and Vascular Institute, Falls Church, Virginia. 7. Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia. Electronic address: gorav@virginia.edu.
Abstract
BACKGROUND: Annular enlargement (AE) is a critical technique to avoid patient-prosthesis mismatch and may help facilitate future valve-in-valve (ViV) transcatheter replacement. We hypothesized that the addition of annular enlargement would increase risk of morbidity and mortality and that the number of annular enlargement procedures is increasing to accommodate future ViV procedures. METHODS: Patients undergoing aortic valve replacement ± coronary surgery (2012 to 2017) were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by annular enlargement and era, pre-ViV (2012 to 2014) vs ViV (2015 to 2017) for univariate analysis. Risk-adjusted outcomes were assessed by hierarchical regression modeling adjusting for predicted risk of mortality. RESULTS: Of 6045 patients, the 300 (5.0%) who received an annular enlargement were younger and more commonly female. Patients receiving an annular enlargement had higher complication rates including operative mortality (4.7% vs 2.5%, P = .024). After risk adjustment, AE was independently associated with increased mortality (odds ratio, 2.06, P = .016) and major morbidity (odds ratio, 1.41, P = .042). The rate of enlargement increased from 3.9% pre-ViV to 6.3% ViV (P < .001). The use of ViV capable valves (bioprosthetic ≥23 mm) from 61% to 67% (P = .001), and more in AE patients (30% vs 11% non-AE). Alternatively, the rate of patient prosthesis mismatch declined from 23% to 16%. CONCLUSIONS: Increasing utilization of AE coincides with a decline in patient prosthesis mismatch and may facilitate future ViV transcatheter aortic valve replacement. However, AE was independently associated with increased morbidity and mortality. High variability in AE volume may be increasing risk and deserves further investigation.
BACKGROUND: Annular enlargement (AE) is a critical technique to avoid patient-prosthesis mismatch and may help facilitate future valve-in-valve (ViV) transcatheter replacement. We hypothesized that the addition of annular enlargement would increase risk of morbidity and mortality and that the number of annular enlargement procedures is increasing to accommodate future ViV procedures. METHODS:Patients undergoing aortic valve replacement ± coronary surgery (2012 to 2017) were extracted from a regional Society of Thoracic Surgeons database. Patients were stratified by annular enlargement and era, pre-ViV (2012 to 2014) vs ViV (2015 to 2017) for univariate analysis. Risk-adjusted outcomes were assessed by hierarchical regression modeling adjusting for predicted risk of mortality. RESULTS: Of 6045 patients, the 300 (5.0%) who received an annular enlargement were younger and more commonly female. Patients receiving an annular enlargement had higher complication rates including operative mortality (4.7% vs 2.5%, P = .024). After risk adjustment, AE was independently associated with increased mortality (odds ratio, 2.06, P = .016) and major morbidity (odds ratio, 1.41, P = .042). The rate of enlargement increased from 3.9% pre-ViV to 6.3% ViV (P < .001). The use of ViV capable valves (bioprosthetic ≥23 mm) from 61% to 67% (P = .001), and more in AE patients (30% vs 11% non-AE). Alternatively, the rate of patient prosthesis mismatch declined from 23% to 16%. CONCLUSIONS: Increasing utilization of AE coincides with a decline in patient prosthesis mismatch and may facilitate future ViV transcatheter aortic valve replacement. However, AE was independently associated with increased morbidity and mortality. High variability in AE volume may be increasing risk and deserves further investigation.
Authors: Michiel D Vriesendorp; Rob A F de Lind van Wijngaarden; Robert J M Klautz Journal: Eur J Cardiothorac Surg Date: 2020-04-01 Impact factor: 4.191
Authors: Michiel D Vriesendorp; Rob A F De Lind Van Wijngaarden; Stuart J Head; Arie-Pieter Kappetein; Graeme L Hickey; Vivek Rao; Neil J Weissman; Michael J Reardon; Michael G Moront; Joseph F Sabik; Robert J M Klautz Journal: Eur Heart J Cardiovasc Imaging Date: 2020-10-01 Impact factor: 6.875