Reduced Incidence of Prosthesis–patient Mismatch and Its Sequelae in Transcatheter Versus Surgical Valve Replacement in High–risk Patients With Severe Aortic Stenosis: A Partner Trial Cohort a Analysis

Weissman, Neil J.; Stewart, William C.; Hahn, Rebecca T.; Hueter, Irene; Kodali, Susheel; Thourani, Vinod H.; Miller, Craig; Svensson, Lars; Herrmann, Howard C.; Smith, Craig S.; Douglas, Pamela S.; Leon, Martin B.

doi:10.1016/s0735-1097(13)61865-3

Cited by 95 publications

(214 citation statements)

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“…The PARTNER trial reported that patients with a higher BSA had significantly higher rates of PPM. (11) In line with that finding, the present study had relatively lower rates of severe PPM (14.3%) as compared with the PARTNER trial (19.7%), given the higher mean BSA in the latter. (11) Moreover, patients in the PARTNER trial who did not have PPM had higher rates of post-procedural PVL.…”

Section: A 3bsupporting

confidence: 88%

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes

Chew¹,

Hon²,

Yip³

et al. 2017

smedj

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INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperativepatients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions.METHODS This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve. RESULTSMean age was 76.8 years (61.0% male), mean body surface area 1.6 m 2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008).CONCLUSION Despite the unique clinical differences in Asian populations, this registry demonstrated favourable midterm clinical and safety outcomes in Asians undergoing TAVI.

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Section: A 3bsupporting

confidence: 88%

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes

Chew¹,

Hon²,

Yip³

et al. 2017

smedj

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show abstract

“…Patients with small aortic root are prone to patient prosthetic mismatch which could result in poorer outcomes (74). In high-risk patients, adding aortic root enlargement with prolongation of surgery may lead to detrimental effects.…”

Section: Sutureless Mini-avr In High Risk Patientsmentioning

confidence: 99%

Minimally invasive aortic valve replacement in high risk patient groups

Fudulu

Lewis

Benedetto³

et al. 2017

J. Thorac. Dis.

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Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.

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“…The presence of severe prosthesis-patient mismatch (PPM) and ensuing high residual transaortic gradients may hinder LV mass regression. 4 Recent studies report that PPM is more frequent and more often severe following surgical AVR (SAVR) than transcatheter AVR (TAVR), and this translated into less LV mass regression and worse survival than those without PPM. 4 The paradox of LV mass regression following SAVR In the PARTNER 1A trial and the Pivotal CoreValve trial, [5][6][7][8] LV mass regression was faster and greater after SAVR compared to TAVR despite higher transaortic pressure gradients and more frequent severe PPM after SAVR.…”

Section: Mass Regression: An Important Goal Of Avrmentioning

confidence: 99%

“…4 Recent studies report that PPM is more frequent and more often severe following surgical AVR (SAVR) than transcatheter AVR (TAVR), and this translated into less LV mass regression and worse survival than those without PPM. 4 The paradox of LV mass regression following SAVR In the PARTNER 1A trial and the Pivotal CoreValve trial, [5][6][7][8] LV mass regression was faster and greater after SAVR compared to TAVR despite higher transaortic pressure gradients and more frequent severe PPM after SAVR. The purpose of the article by Kadkhodayan and colleagues 7 published in this first issue of Structural Heart was to identify the reasons for this paradox by using the serial echocardiography data analyzed by an independent echocardiography core laboratory in patients with severe AS randomized to SAVR vs. TAVR with the CoreValve bioprosthesis.…”

Section: Mass Regression: An Important Goal Of Avrmentioning

confidence: 99%

Reduced Incidence of Prosthesis–patient Mismatch and Its Sequelae in Transcatheter Versus Surgical Valve Replacement in High–risk Patients With Severe Aortic Stenosis: A Partner Trial Cohort a Analysis

Cited by 95 publications

References 0 publications

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes

Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: two-year Valve Academic Research Consortium-2 outcomes

Minimally invasive aortic valve replacement in high risk patient groups

The Left Ventricular Mass Regression Paradox following Surgical Valve Replacement: A Real Phenomenon or a Mathematical Glitch?

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