Long‑term outcomes of transcatheter self-expanding aortic valve implantations in inoperable and high surgical–risk patients with severe aortic stenosis: a single-center single-valve registry

Dębiński, Marcin; Domaradzki, Wojciech; Fil, Wojciech; Milewski, Krzysztof; Buszman, Piotr P.; Kachel, Mateusz; Brączkowski, Jakub; Gerber, Witold; Cisowski, Marek; Bochenek, Andrzej; Zejda, Jan

doi:10.33963/kp.15821

Cited by 5 publications

(5 citation statements)

References 23 publications

(25 reference statements)

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“…Our study showed a predictive value of Euroscore II for longterm mortality after TAVI at each stage of observation, but just after 24-month follow-up in SAVR patients. Dębiński et al [7] confirmed a worse prognosis in TAVI patients with EuroSCORE II greater than 6%.…”

Section: Discussionmentioning

confidence: 94%

Comparison of long-term outcomes and risk factors of aortic stenosis treatment in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

et al. 2022

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Background: Aortic stenosis (AS) is the most common valvular heart disease and untreated has a bleak prognosis. The only effective method of treatment is valve replacement, surgical (SAVR), or transcatheter (TAVI). Aims:We decided to analyze outcomes and predictors of long-term mortality in patients undergoing TAVI and SAVR.Methods: A retrospective analysis of 1229 patients with advanced AS, comprising TAVI (n = 211), SAVR (n = 556), SAVR, and additional procedures (n = 462), operated on from 2014 to 2018, was performed.Results: No significant differences between SAVR and TAVI were found for 24-month mortality in groups of consecutive patients. Postoperative stroke or transient ischemic attack (TIA), chronic obstructive pulmonary disease (COPD), and transfusion of red blood cells (RBCs) were independent predictors of 1-year mortality after SAVR. The above-mentioned factors regarding the increased estimated surgery risk in the EuroSCORE II (>4%) were predictors of 2-years mortality after SAVR. Risk factors for 6-and 12-month mortality after TAVI were EuroSCORE II, new onset of atrial fibrillation (NOAF), and the increased RBC distribution width (RDW). Postoperative respiratory failure was an independent risk factor for 6-, 12-and 24-month mortality in both groups of patients.Conclusions: There were no significant differences regarding prognosis after TAVI and SAVR at the 24-month follow-up in the propensity score matching model. Independent predictive factors of late mortality after both procedures were EuroSCORE II and respiratory failure. Independent predictive factors of late mortality specific for TAVI were NOAF, increased RDW, and for SAVR: TIA, stroke, COPD, and RBC transfusion.

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Section: Discussionmentioning

confidence: 94%

Comparison of long-term outcomes and risk factors of aortic stenosis treatment in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

et al. 2022

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“…Indeed, several randomized clinical trials compared those procedures and confirmed that TAVI was non-inferior and even superior to SAVR with regard to clinical outcomes [3,[7][8][9].…”

Section: Introductionmentioning

confidence: 98%

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

et al. 2022

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Background: Aortic stenosis (AS) is the most common acquired valvular disease. There are two methods of interventional treatment: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between SAVR and TAVI depends on the assessment of individual perioperative risk and long-term treatment outcomes. It is essential to identify factors that may influence the outcomes of the treatment to minimize their negative effects. Aims:The study aimed to identify the most important risk factor which affects treatment outcomes in patients with AS undergoing SAVR/TAVI. Methods:This study reviewed retrospectively patients with AS who underwent SAVR or TAVI. The primary outcomes included incidences of major adverse cardiovascular events (MACE) defined as cardiovascular death, stroke, and hospitalization for cardiovascular issues assessed over a one-year follow-up period. An occurrence of postprocedural AKI (acute kidney injury) was identified as an independent predictor of MACE. Results:The study included 78 patients, with the same number of subjects in each group (SAVR/TAVI [n = 39]). Twenty-nine patients developed AKI. It was similar in both groups (SAVR [n = 15]; TAVR [n = 14]). In the SAVR group, 13 (33%) patients developed at least one MACE compared to 5 (13%) patients in the TAVI group. AKI and the type of procedure (SAVR) were shown to be significantly and independently associated with the development of MACE (P = 0.01 and P = 0.03, respectively) as shown in the Cox multivariable regression model. Conclusions:Our study demonstrated that AKI is the strongest predictor of major adverse cardiovascular events after using both methods of aortic valve replacement (SAVR/TAVI).

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“…The above mentioned factors should be assessed by a qualified heart team and discussed in light of the center’s experience in treatment with both methods. The TAVI procedure is used successfully in patients at high surgical risk but may be also performed in patients younger than 75 years and with intermediate or low surgical risk [ 13 , 14 , 15 , 16 ]. Studies have shown no worse (non-inferiority) outcomes for patients with high and intermediate surgical risk undergoing TAVI compared to SAVR in a follow-up of up to 5 years [ 6 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ].…”

Section: Introductionmentioning

confidence: 99%

Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management

Szotek,

Drużbicki,

Sabatowski

et al. 2023

JCM

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Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.

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Long‑term outcomes of transcatheter self-expanding aortic valve implantations in inoperable and high surgical–risk patients with severe aortic stenosis: a single-center single-valve registry

Cited by 5 publications

References 23 publications

Comparison of long-term outcomes and risk factors of aortic stenosis treatment in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

Comparison of long-term outcomes and risk factors of aortic stenosis treatment in patients undergoing transcatheter aortic valve implantation and surgical aortic valve replacement

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management

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