Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement

Witberg, Guy; Landes, Uri; Talmor‐Barkan, Yeela; Richter, Ilan; Barbanti, Marco; Valvo, Roberto; Ooms, Joris F.; Islas, Fabián; Marroquín, Luis; Sedaghat, Alexander; Sugiura, Atsushi; Masiero, Giulia; Fiorina, Claudia; Arzamendi, Dabit; Santos‐Martínez, Sandra; Fernández‐Vázquez, Felipe; Baz, José Antonio; Steblovnik, Klemen; Mauri, Victor; Adam, Matti; Merdler, Ilan; Ruile, Philipp; Codner, Pablo; Grasso, Carmelo; Branca, Luca; Estévez‐Loureiro, Rodrigo; Benito‐González, Tomas; Amat‐Santos, Ignacio J.; Mylotte, Darren; Bunc, Matjaž; Tarantini, Giuseppe; Nombela‐Franco, Luis; Søndergaard, Lars; Mieghem, Nicolas Van; Finkelstein, Ariel; Kornowski, Ran

doi:10.1016/j.jcin.2022.05.004

Cited by 10 publications

(12 citation statements)

References 17 publications

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“…The distribution of patients according to the case sequence number and the type of implanted device is shown in Figure 2. At a median follow-up time of 28 (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36) months, all-cause mortality was 22.0%.…”

Section: Resultsmentioning

confidence: 99%

“…The Learning Curve in Balloon-Expandable versus Self-Expandable TAVI operators, these features of the implantation process could translate into differences in several important procedural outcomes [24]. Among these, the higher rate of more than mild paravalvular AR, the higher rate of postprocedural conduction abnormalities, and the need for a new pacemaker were more frequently associated with SE valves and were predictors of increased mortality [3,[8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…These studies included procedures performed with both BE and SE devices and did not analyze outcomes according to the prosthesis design. Recently, the AMTRAC Registry compared the outcomes of TAVI procedures using third-generation BE and SE devices stratified by center valve preference [24]. A center was defined as BE- or SE-dominant if one transcatheter heart valve type accounted for 66.6–90% of the total procedural volume [24].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the AMTRAC Registry compared the outcomes of TAVI procedures using third-generation BE and SE devices stratified by center valve preference [24]. A center was defined as BE- or SE-dominant if one transcatheter heart valve type accounted for 66.6–90% of the total procedural volume [24]. While periprocedural outcomes, more than mild paravalvular AR, and 2-year mortality were worse when TAVI was performed using SE devices at BE-dominant centers, outcomes were similar regardless of the prosthesis type at SE-dominant institutions [24].…”

Section: Discussionmentioning

confidence: 99%

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The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation

Istrate,

Dregoesc,

Bolboaca

et al. 2023

Cardiology

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Introduction: Balloon-expandable (BE) and self-expandable (SE) prostheses are the main types of devices currently used in transcatheter aortic valve implantation (TAVI). Despite the different designs, clinical practice guidelines do not make any specific recommendation on the selection of one device over the other. Most operators are trained in using both BE and SE prostheses, but operator experience with each of the two designs might influence patient outcomes. The aim of this study was to compare the immediate and mid-term clinical outcomes during the learning curve in BE versus SE TAVI. Methods: The transfemoral TAVI procedures performed in a single center between July 2017 and March 2021 were grouped according to the type of implanted prosthesis. The procedures in each group were ordered according to the case sequence number. For each patient, a minimum follow-up time of 12 months was required for inclusion in the analysis. The outcomes of the BE TAVI procedures were compared with the outcomes of the SE TAVI procedures. Clinical endpoints were defined according to the Valve Academic Research Consortium 3 (VARC-3). Results: The median follow-up time was 28 months. Each device group included 128 patients. In the BE group, case sequence number predicted mid-term all-cause mortality at an optimal cutoff value ≤58 procedures (AUC 0.730; 95% CI: 0.644–0.805; p < 0.001), while in the SE group, the cutoff value was ≤85 procedures (AUC 0.625; 95% CI: 0.535–0.710; p = 0.04). A direct comparison of the AUC showed that case sequence number was equally adequate in predicting mid-term mortality, irrespective of prosthesis type (p = 0.11). A low case sequence number was associated with an increased rate of VARC-3 major cardiac and vascular complications (OR 0.98 95% CI: 0.96–0.99; p = 0.03) in the BE device group, and with an increased rate of post-TAVI aortic regurgitation ≥ grade II (OR 0.98; 95% CI: 0.97–0.99; p = 0.03) in the SE device group. Conclusions: In transfemoral TAVI, case sequence number influenced mid-term mortality irrespective of prosthesis type, but the learning curve was longer in the case of SE devices.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation

Istrate,

Dregoesc,

Bolboaca

et al. 2023

Cardiology

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“…One aspect we should also consider is the impact of center valve preference on SEV outcomes (unfortunately not described in the original studies). Recently, the AMTRAC Registry 30 compared outcomes of TAVI procedures using third‐generation balloon‐expandable valves (BEVs) and SEVs stratified by center valve preference and showed that periprocedural outcomes are worse when TAVI is performed using SEVs at BEV‐dominant centers. Our present study is unable to offer any insight into this aspect due to lack of data in the original studies; however, we recognize the possibility of a modulating effect of this variable on our findings which should be clarified in future studies.…”

Section: Discussionmentioning

confidence: 99%

Cusp‐overlap versus coplanar view in transcatheter aortic valve implantation with self‐expandable valves: A meta‐analysis of comparative studies

Sá

Eynde

Jacquemyn

et al. 2023

Cathet Cardio Intervent

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Background Permanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve implantation (TAVI). The cusp‐overlap view (COV) was adopted to reduce PPI risk after TAVI with self‐expandable valves (SEVs); however, the evidence remains scarce. We performed a systematic review with meta‐analysis comparing COV and the standard coplanar view (CPV) technique to evaluate their effectiveness and safety. Methods Following the PRISMA statement, data were extracted from studies published by August 2022 and found in PubMed/MEDLINE, EMBASE, CENTRAL/CCTR, http://ClinicalTrials.gov, SciELO, LILACS, and Google Scholar. The primary outcome of interest was post‐procedural PPI and the secondary outcomes were new left bundle branch block (LBBB), moderate/severe paravalvular leak (PVL), valve dislocation (pop‐out); need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, implantation depth (mm), and post‐TAVI mean gradients (mmHg). Results Eleven studies met our eligibility criteria and included 1464 patients in the COV group and 1743 patients in the CPV group. Patients who underwent TAVI with COV had lower risk of PPI (odds ratio 0.48; 95% confidence interval [CI] 0.33–0.70; p = 0.001) and higher implantation depths with COV (mean difference −0.83; 95% CI −1.2 to −0.45; p < 0.001). We did not observe any statistically significant differences in the rates of new LBBB, moderate/severe PVL, valve dislocation, need of second transcatheter heart valve, 30‐day mortality, stroke, conversion to surgery, coronary obstruction, and post‐TAVI mean gradients (mmHg). Conclusion In TAVI with SEVs, the application of COV is associated with lower risk of PPI compared with the standard CPV without increasing risk for adverse outcomes.

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Transcatheter aortic valve replacement beneficial in patients with severely reduced left ventricle ejection fraction: does the type of valve also matter?

Protasiewicz

2024

ESC Heart Failure

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Aortic stenosis is a disease mainly affecting older patients, and most of them have preserved left ventricle ejection fraction. 1 In this issue of ESC Heart Failure, Matta et al. analyse data from the FRANCE-TAVI Registry to assess the safety, efficacy, and outcomes of transcatheter aortic valve replacement (TAVR) in patients with severe cardiac dysfunction. 2 In the study, the group of 157 patients with left ventricular ejection fraction (LVEF) below ≤35% was compared with their 820 counterparts with normal cardiac function.Data on the outcomes of TAVR in patients with severe LV dysfunction are sparse, even though in daily clinical practice, such patients may represent up to 13% of those undergoing TAVR. 3 Many factors may predict or influence the long-term outcomes after the TAVI identified already. 4-7 Matta's retrospective, single-centre cohort study offers valuable insights into a group of patients that have often been poorly represented or excluded in previous trials and analyses.The study's primary endpoint was to assess the success rate, risk of complications, changes in LVEF, and survival post-TAVR in patients with severely reduced versus preserved LVEF. The secondary endpoint was to compare survival outcomes post-TAVR in patients with LVEF ≤35% treated with self-expanding valves (SEV) versus balloon-expandable valves BEV.Characteristics of patients and TAVR procedures in those with LVEF <35% and >50% differed by several variables that may have a prognostic impact, but mainly in favour of the normal LV group. However, during a mean follow-up of more than 3 years, no differences in all-cause mortality were observed between both groups at different time points. There is conflicting information on whether LVEF is a risk factor for poor TAVR outcome. [8][9][10][11] Matta et al. observation indicates that baseline left ventricular function may be not the main dominant predictor of postoperative prognosis, and patients with severely depressed LVEF may benefit from TAVR comparably to patients with preserved LVEF.

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Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement

Cited by 10 publications

References 17 publications

The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation

The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation

Cusp‐overlap versus coplanar view in transcatheter aortic valve implantation with self‐expandable valves: A meta‐analysis of comparative studies

Transcatheter aortic valve replacement beneficial in patients with severely reduced left ventricle ejection fraction: does the type of valve also matter?

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