TAVI for patients with normal-flow low-gradient compared to high-gradient aortic stenosis

Steffen, Julius; Andreae, David; Näbauer, Michael; Reißig, Nikolas; Doldi, Philipp M.; Haum, Magda; Orban, Martin; Theiß, Hans; Rizas, Konstantinos D.; Braun, Daniel; Peterß, Sven; Hausleiter, Jörg; Maßberg, Steffen; Deseive, Simon

doi:10.1016/j.ijcard.2022.10.143

Cited by 2 publications

(1 citation statement)

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“…Within the past two decades, transcatheter aortic valve replacement (TAVR) has become an indispensable pillar in the treatment of severe aortic stenosis (AS). Since multiple clinical trials and registries have proven the safety and effectiveness of treating severe AS by TAVR [ 1 , 2 ], research is now heading towards gaining a deeper pathophysiological understanding of this heterogeneous disease entity [ 3 ] in order to further optimize patient selection and treatment.…”

Section: Introductionmentioning

confidence: 99%

Cardio-hepatic syndrome in patients undergoing transcatheter aortic valve replacement

et al. 2023

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Background Cardiohepatic syndrome (CHS) has been identified as an important but underrecognized survival predictor in multiple cardiovascular disease entities. The objectives of this study were to evaluate the prevalence and prognostic value of CHS in patients undergoing TAVR for severe aortic stenosis (AS). Methods The study included patients with available laboratory parameters of hepatic function who underwent TAVR from July 2013 until December 2019 at our center. CHS was defined as an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal (bilirubin, alkaline phosphatase, and gamma glutamyl transferase). Study endpoints were three-year survival, technical and device failure (VARC 3), as well as New York Heart Association (NYHA) functional class at follow-up. Results Among a total of 953 analyzed patients (47.6% females, median age 80.0 [76.0–85.0] years) CHS was present in 212 patients (22.4%). In patients with vs. without CHS, rates of technical (6.1% vs. 8.4%, p = 0.29) and device failure (18.9% vs. 17.3%, p = 0.59) were comparable. NYHA functional class at baseline and follow-up was more severe in patients with CHS. Nevertheless, heart failure symptoms improved from baseline to follow-up irrespective of hepatic function. Three-year survival rates were significantly lower in patients with CHS (49.4 vs. 65.4%, p < 0.001). The predictive value of CHS persisted after adjustment in a multivariable analysis (hazard ratio 1.58, p < 0.01). Conclusion In patients undergoing TAVR, CHS is prevalent in 22% of patients and is associated with increased postinterventional mortality. Thus, CHS should be included in the decision-making process within the TAVR heart team. Graphical abstract Cardiohepatic syndrome (CHS) as defined by an elevation of at least two of three laboratory cholestasis parameters above the upper limit of normal was prevalent in 22% of patients undergoing TAVR for severe AS. The presence of CHS was associated with more severe heart failure symptoms and worse three-year survival.

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Section: Introductionmentioning

confidence: 99%