Journal article
Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation.
- Yoon SH Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Schmidt T Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Bleiziffer S Clinic for Cardiovascular Surgery, German Heart Center Munich, Germany.
- Schofer N Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany.
- Fiorina C Cardiothoracic Department, Spedali Civili Brescia, Brescia, Italy.
- Munoz-Garcia AJ Hospital Universitaro Virgen de la Victoria, Spain.
- Yzeiraj E Hamburg University Cardiovascular Center, Hamburg, Germany.
- Amat-Santos IJ Institute of Heart Sciences, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
- Tchetche D Department of Cardiology, Clinique Pasteur, Toulouse, France.
- Jung C Division of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Dusseldorf, Dusseldorf, Germany.
- Fujita B Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
- Mangieri A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
- Deutsch MA Clinic for Cardiovascular Surgery, German Heart Center Munich, Germany; German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany.
- Ubben T Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Deuschl F Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany.
- Kuwata S University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- De Biase C Department of Cardiology, Clinique Pasteur, Toulouse, France.
- Williams T Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Dhoble A Department of Cardiology, University of Texas Health Science Center, Houston, Texas.
- Kim WK Kerckhoff Heart and Thorax Center, Department of Cardiology/Cardiac Surgery, Bad Nauheim, Germany.
- Ferrari E Cardiac Surgery Unit, Cardiocentro Ticino Foundation, Lugano, Switzerland.
- Barbanti M Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
- Vollema EM Department of Cardiology, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands.
- Miceli A Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy.
- Giannini C Department Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
- Attizzani GF The Valve and Structural Heart Interventional Center, University Hospitals Case Medical Center, Cleveland, Ohio.
- Kong WKF Department of Cardiology, National University Heart Centre, Singapore.
- Gutierrez-Ibanes E Department of Cardiology, Hospital General Universitario Gregorio Maranon, Madrid, Spain.
- Jimenez Diaz VA Cardiology Department, University Hospital of Vigo, Vigo, Spain.
- Wijeysundera HC Division of Cardiology, Sunnybrook Health Science Centre, Toronto, Ontario, Canada.
- Kaneko H Heart Center Brandenburg in Bernau and Brandenburg Medical School, Bernau, Germany.
- Chakravarty T Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Makar M Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Sievert H Department of Cardiology and Vascular Medicine, CardioVascular Center, Frankfurt, Germany.
- Hengstenberg C German Center for Cardiovascular Research, Partner Site Munich Heart Alliance, Munich, Germany; Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
- Prendergast BD Department of Cardiology, St Thomas' Hospital, London, United Kingdom.
- Vincent F Department of Cardiology, CHU Lille, Inserm, U1011, Université Lille, Lille, France.
- Abdel-Wahab M Heart Center, Segeberger Kliniken, Bad Segeberg, German.
- Nombela-Franco L Division of Cardiology, Hospital Clinicio San Carlos, Madrid, Spain.
- Silaschi M Department of Cardiac Surgery, University of Halle, Halle, Germany.
- Tarantini G Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padova, Padova, Italy.
- Butter C Heart Center Brandenburg in Bernau and Brandenburg Medical School, Bernau, Germany.
- Ensminger SM Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
- Hildick-Smith D Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom.
- Petronio AS Department Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
- Yin WH Division of Cardiology, Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.
- De Marco F Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy.
- Testa L Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy.
- Van Mieghem NM Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
- Whisenant BK Division of Cardiovascular Diseases, Intermountain Heart Institute, Salt Lake City, Utah.
- Kuck KH Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Colombo A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
- Kar S Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California.
- Moris C Hospital Universitario Central de Asturias, Oviedo, Spain.
- Delgado V Department of Cardiology, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands.
- Maisano F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Nietlispach F University Heart Center, University Hospital Zurich, Zurich, Switzerland.
- Mack MJ Department of Cardiovascular Disease, Baylor Scott and White Health Care System, Plano, Texas.
- Schofer J Hamburg University Cardiovascular Center, Hamburg, Germany.
- Schaefer U Department of General and interventional Cardiology, University Heart Center, Hamburg, Germany.
- Bax JJ Department of Cardiology, Leiden University Medical Center, Leiden 2333 ZA, the Netherlands.
- Frerker C Department of Cardiology, Asklepios Klink St. Georg, Hamburg, Germany.
- Latib A Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus & San Raffaele Scientific Institute, Milan, Italy San Raffaele Hospital, Milan, Italy.
- Makkar RR Department of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California. Electronic address: Raj.Makkar@cshs.org.
- 2017-12-02
Published in:
- Journal of the American College of Cardiology. - 2017
aortic regurgitation
transcatheter valve implantation
Aged
Aged, 80 and over
Aortic Valve
Aortic Valve Insufficiency
Catheterization, Peripheral
Female
Femoral Artery
Heart Valve Prosthesis
Humans
International Cooperation
Male
Mortality
Outcome and Process Assessment, Health Care
Postoperative Complications
Prosthesis Design
Quality Improvement
Registries
Risk Assessment
Severity of Illness Index
Transcatheter Aortic Valve Replacement
English
BACKGROUND
Limited data exist about safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with pure native aortic regurgitation (AR).
OBJECTIVES
This study sought to compare the outcomes of TAVR with early- and new-generation devices in symptomatic patients with pure native AR.
METHODS
From the pure native AR TAVR multicenter registry, procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between early- and new-generation devices.
RESULTS
A total of 331 patients with a mean STS score of 6.7 ± 6.7 underwent TAVR. The early- and new-generation devices were used in 119 patients (36.0%) and 212 patients (64.0%), respectively. STS score tended to be lower in the new-generation device group (6.2 ± 6.7 vs. 7.6 ± 6.7; p = 0.08), but transfemoral access was more frequently used in the early-generation device group (87.4% vs. 60.8%; p < 0.001). Compared with the early-generation devices, the new-generation devices were associated with a significantly higher device success rate (81.1% vs. 61.3%; p < 0.001) due to lower rates of second valve implantation (12.7% vs. 24.4%; p = 0.007) and post-procedural AR ≥ moderate (4.2% vs. 18.8%; p < 0.001). There were no significant differences in major 30-day endpoints between the 2 groups. The cumulative rates of all-cause and cardiovascular death at 1-year follow-up were 24.1% and 15.6%, respectively. The 1-year all-cause mortality rate was significantly higher in the patients with post-procedural AR ≥ moderate compared with those with post-procedural AR ≤ mild (46.1% vs. 21.8%; log-rank p = 0.001). On multivariable analysis, post-procedural AR ≥ moderate was independently associated with 1-year all-cause mortality (hazard ratio: 2.85; 95% confidence interval: 1.52 to 5.35; p = 0.001).
CONCLUSIONS
Compared with the early-generation devices, TAVR using the new-generation devices was associated with improved procedural outcomes in treating patients with pure native AR. In patients with pure native AR, significant post-procedural AR was independently associated with increased mortality.
Limited data exist about safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with pure native aortic regurgitation (AR).
OBJECTIVES
This study sought to compare the outcomes of TAVR with early- and new-generation devices in symptomatic patients with pure native AR.
METHODS
From the pure native AR TAVR multicenter registry, procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between early- and new-generation devices.
RESULTS
A total of 331 patients with a mean STS score of 6.7 ± 6.7 underwent TAVR. The early- and new-generation devices were used in 119 patients (36.0%) and 212 patients (64.0%), respectively. STS score tended to be lower in the new-generation device group (6.2 ± 6.7 vs. 7.6 ± 6.7; p = 0.08), but transfemoral access was more frequently used in the early-generation device group (87.4% vs. 60.8%; p < 0.001). Compared with the early-generation devices, the new-generation devices were associated with a significantly higher device success rate (81.1% vs. 61.3%; p < 0.001) due to lower rates of second valve implantation (12.7% vs. 24.4%; p = 0.007) and post-procedural AR ≥ moderate (4.2% vs. 18.8%; p < 0.001). There were no significant differences in major 30-day endpoints between the 2 groups. The cumulative rates of all-cause and cardiovascular death at 1-year follow-up were 24.1% and 15.6%, respectively. The 1-year all-cause mortality rate was significantly higher in the patients with post-procedural AR ≥ moderate compared with those with post-procedural AR ≤ mild (46.1% vs. 21.8%; log-rank p = 0.001). On multivariable analysis, post-procedural AR ≥ moderate was independently associated with 1-year all-cause mortality (hazard ratio: 2.85; 95% confidence interval: 1.52 to 5.35; p = 0.001).
CONCLUSIONS
Compared with the early-generation devices, TAVR using the new-generation devices was associated with improved procedural outcomes in treating patients with pure native AR. In patients with pure native AR, significant post-procedural AR was independently associated with increased mortality.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.jacc.2017.10.006
- PMID 29191323
- Persistent URL
- https://folia.unifr.ch/global/documents/191249
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