Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?

Colli, Andrea; Besola, Laura; Salizzoni, Stefano; Gregori, Darío; Tarantini, Giuseppe; Agrifoglio, Marco; Chieffo, Alaide; Regesta, Tommaso; Gabbieri, Davide; Saia, Francesco; Tamburino, Corrado; Ribichini, Flavio; Valsecchi, Orazio; Loi, Bruno; Iadanza, Alessandro; Stolcova, Miroslava; Minati, Alessandro; Martinelli, Gianluca; Bedogni, Francesco; Petronio, Anna Sonia; Dallago, Michele; Cappai, Antioco; D’Onofrio, Augusto; Gerosa, Gino

doi:10.1016/j.ijcard.2017.02.005

Cited by 18 publications

(7 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The impact of PVL and PPM on clinical outcome and LV recovery after TAVR is still a matter of debate, and the scientific evidence on this field are controversial. Previous reports suggested that mild PVL is commonly observed after TAVR and usually leads to a benign outcome (36). However, a meta-analysis of 45 studies including around 13,000 patients concluded that moderate or greater post-TAVR PVL was associated with a more than 2-fold increase in overall all-cause mortality (37).…”

Section: Discussionmentioning

confidence: 99%

Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Fraccaro

Tarantini²,

Rosato³

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

Patients with non-paradoxical low-flow–low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF ≤50% and mean aortic gradient <40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (n = 389) with those who underwent surgical aortic valve replacement (SAVR, n = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 ± 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 ± 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term.

show abstract

Section: Discussionmentioning

confidence: 99%

Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Fraccaro

Tarantini²,

Rosato³

et al. 2022

Front. Cardiovasc. Med.

Self Cite

View full text Add to dashboard Cite

show abstract

“…PVL has shown to be correlated to increased mortality at 1 year (19,20), especially in patients with preoperative valve stenosis and no regurgitation (with no previous ventricular dilation) (21). For this reason, when it comes to treating intermediate and low risk patients, the occurrence of "more than mild" PVL should unquestionably be avoided.…”

Section: Hemodynamic Performancementioning

confidence: 99%

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

D’Onofrio

Fabozzo

Gerosa

2017

Ann. Cardiothorac. Surg.

Self Cite

View full text Add to dashboard Cite

Current surgical treatment options for aortic valve stenosis (AS), as alternatives to that of conventional operation with a midline sternotomy, include sutureless valve replacement (SUAVR) and transcatheter valve implantation (TAVI). Patients with high surgical risk, or those who are judged to be inoperable, are typically good candidates for the TAVI procedure. The best treatment option in patients with an intermediate risk profile, however, the so called "grey zone", is still currently under debate. Sutureless aortic valve replacement has been recently presented as a valid alternative for patients with low-to intermediate-risk. Data available on prostheses' hemodynamic performance and patients' clinical outcomes play a crucial role in the process of device selection. Compared to TAVI, SUAVR provides lower rate of significant postoperative paravalvular leak (PVL), which has shown to be a predictor for mortality. On the contrary, transcatheter valves seem to perform better in terms of transvalvular mean and peak gradients. Therefore, SUAVR and TAVI are both reliable options in patients with severe aortic valve stenosis, as an alternative to conventional surgery, and the choice of the best device should be tailored to patient's anatomical and surgical characteristics.

show abstract

“…Many pivotal TAVR clinical trials have excluded patients with severe AR and reports on outcomes in the MAVD population are limited [ 8 – 10 ]. The data available is inconclusive in that some studies have shown improved survival among MAVD patients after TAVR [ 11 – 13 ], while others have not [ 14 – 16 ]. We performed a meta-analysis to compare the 1-year mortality outcomes of TAVR among patients with MAVD and AS.…”

Section: Introductionmentioning

confidence: 99%

Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis

Ugwu

Kandah

Ndulue³

et al. 2022

Cardiol Ther

View full text Add to dashboard Cite

Introduction Transcatheter aortic valve replacement (TAVR) has become a suitable alternative to surgical aortic valve replacement (SAVR) for the treatment of symptomatic severe aortic stenosis (AS). A high proportion of patients with AS have mixed aortic valve disease (MAVD) with mild or more concurrent aortic regurgitation (AR). Differential outcomes of TAVR among patients with AS and MAVD have not been well characterized. We compared 1-year mortalities following TAVR among patients with MAVD and AS. Methods We conducted a meta-analysis of studies published in PubMed/Medline. The primary outcome was 1-year all-cause mortality following TAVR among patients with MAVD vs. AS. Secondary endpoints were: (1) incidence of AR within 30 days following TAVR (post TAVR AR); and (2) 1-year all-cause mortality within each group stratified according to severity of post TAVR AR. Results Nine studies involving 9505 participants were included in the analysis. At 1 year following TAVR, mortality was lower in MAVD than in AS; HR 0.89, 95% CI 0.81–0.98. The mortality advantage increased when pre-TAVR AR was moderate or more; HR 0.84, 95% CI 0.72–0.99. The mortality advantage was attenuated after correction for publication bias. There was a higher risk of post TAVR AR in the MAVD group; OR 1.51, 95% CI 1.20–1.90 but the impact on mortality of moderate vs. mild post TAVR AR was greater among patients with AS than in patients with MAVD HR 1.67 95% CI 0.89–3.14 vs. 0.93 95% CI 0.47–1.85. Conclusions Patients with MAVD have similar or improved survival 1 year after TAVR compared to those with AS. Supplementary Information The online version contains supplementary material available at 10.1007/s40119-022-00293-3.

show abstract

Does pre-existing aortic regurgitation protect from death in patients who develop paravalvular leak after TAVI?

Abstract: In patients with severe AS treated with balloon-expandable TAVI, the presence of PVL, but not pre-procedural AR, was a major predictor of adverse outcome. Preoperative LV dilatation seemed to offer some clinical advantages.

Cited by 18 publications

References 35 publications

Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves

Comparison of hemodynamic and clinical outcomes of transcatheter and sutureless aortic bioprostheses: how to make the right choice in intermediate risk patients

Comparative Outcomes of TAVR in Mixed Aortic Valve Disease and Aortic Stenosis: A Meta-analysis

Contact Info

Product

Resources

About