of age, either type of valve prosthesis can be chosen. The aim of this study was to assess the mortality and valverelated complications and compare the long-term outcomes of mechanical vs. bioprosthetic valves in Japanese patients undergoing aortic valve replacement (AVR) stratified into 3 age groups (<60 years; 60-69 years, and ≥70 years).
Methods
PatientsThis study was a pooled analysis of 2 large retrospective T he American College of Cardiology/American Heart Association (ACC/AHA) recently published their revised guidelines on the selection of prosthetic valves. 1 According to their class I recommendation, patient values and preferences must be taken into account, based on full disclosure and understanding of the indications for anticoagulant therapy and the potential need for and risk of reoperation. Besides patient preference, age has been one of the most important factors influencing prosthetic valve choice: mechanical valves are recommended for patients <60 years of age, and bioprosthetic valves for those >70 years of age. For those between 60 and 70 years Background: The aim of this study was to assess the long-term outcomes of aortic valve replacement (AVR) with either mechanical or bioprosthetic valves according to age at operation.
Background:We aimed to clarify the predictors of death or heart failure (HF) in elderly patients who undergo transcatheter aortic valve replacement (TAVR).
Methods and Results:We prospectively enrolled 83 patients (age, 83±5 years) who underwent transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET) with impedance cardiography post-TAVR. We investigated the association of TTE and CPET parameters with death and the combined outcome of death and HF hospitalization. Over a follow-up of 19±9 months, peak oxygen uptake (V O2) was not associated with death or the combined outcome. The minimum ratio of minute ventilation (V E) to carbon dioxide production (V CO2) and the V E vs. V CO2 slope were higher in patients with the combined outcome. After adjusting for age, sex, Society of Thoracic Surgeons score and peak V O2, ventilatory efficacy parameters remained independent predictors of the combined outcome (minimum V E/V O2: hazard ratio, 1.108; 95% confidence interval, 1.010-1.215; P=0.031; V E vs. V CO2 slope: hazard ratio, 1.035; 95% confidence interval, 1.001-1.071; P=0.044), and had a greater area under the receiver-operating characteristic curve. The V E vs. V CO2 slope ≥34.6 was associated with higher rates of the combined outcome, as well as lower cardiac output at peak work rate during CPET.
Conclusions:In elderly patients, lower ventilatory efficacy post-TAVR is a predictor of death and HF hospitalization, reflecting lower cardiac output at peak exercise.
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