Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

Abdelghani, Mohammad; Serruys, Patrick W.

doi:10.1161/circinterventions.115.002944

Cited by 10 publications

(9 citation statements)

References 172 publications

(200 reference statements)

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“…Fostered by refinements in device technology, improved imaging, and streamlining of the procedure, transcatheter aortic valve replacement (TAVR) plays an increasingly important role in the treatment of severe, symptomatic aortic stenosis. 1,2 A decline in peri-procedural complications propelled expansion of TAVR to intermediate and low risk patients, and has shifted the focus of ongoing investigations to determinants of long term outcome. Risk scoring systems are instrumental to balance the expected benefits against the probability of adverse events, and represent a useful tool to properly inform physicians, counsel patients, and optimize the allocation of health care resources.…”

Section: Introductionmentioning

confidence: 99%

Predicting Mortality After Transcatheter Aortic Valve Replacement

Pilgrim

Franzone

Stortecky

et al. 2017

Circ: Cardiovascular Interventions

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In a large, multicenter, non-US cohort of patients with transcatheter aortic valve replacement, the validation of the TVT registry model demonstrated moderate discrimination and good calibration for the prediction of in-hospital and 30-day mortality. As a result, the TVT registry model should be considered an alternative to the Society of Thoracic Surgeons Predicted Risk of Mortality score for decision making and assessment of early outcome in patients eligible for transcatheter aortic valve replacement.

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Section: Introductionmentioning

confidence: 99%

Predicting Mortality After Transcatheter Aortic Valve Replacement

Pilgrim

Franzone

Stortecky

et al. 2017

Circ: Cardiovascular Interventions

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Section: Introductionmentioning

confidence: 99%

“…The comparisons between TAVI and SAVR indicate favourable results for TAVI at higher Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) but appear similar among patients with STS PROM below 6-8% 1 . For patients with increased surgical risk, non-inferiority and even superiority of TAVI compared with SAVR has been demonstrated consistently [1][2][3][4][5] . However, a recent STS database survey including 113,377 patients with a mean age of 65.3±13.0 years and an average STS score of 1.67±0.94% indicates that 80% of all SAVR patients are at low risk for SAVR based on an STS score of <4% 6 .…”

Section: Introductionmentioning

confidence: 99%

One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial

Serruys¹,

Modolo²,

Reardon³

et al. 2018

EuroIntervention

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Aims:The indication for transcatheter aortic valve implantation (TAVI) has evolved from inoperable patients to patients at increased surgical risk. In low-risk patients, surgical aortic valve replacement (SAVR) remains the standard of care. The aim of this study was to explore the outcomes of TAVI and SAVR in patients with a Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score below 3% in the SURTAVI trial.Methods and results: In SURTAVI, patients at intermediate surgical risk based on Heart Team consensus were randomised to TAVI or SAVR. We stratified the overall patient population into quintiles based on the STS PROM score; the one-year mortality was correlated with the mean STS PROM score in each quintile. The quintiles were regrouped into three clinically relevant categories of STS score: less than 3%, 3 to <5%, and >5%. All-cause mortality or disabling stroke in each risk stratum was compared between TAVI and SAVR. Linear regressions between mean values of STS PROM in each quintile and observed allcause mortality at one year showed great association for the global population (r 2 =0.92), TAVI (r 2 =0.89) and SAVR cohorts (r 2 = 0.73). All-cause mortality or disabling stroke of TAVI vs. SAVR was 1.5% vs. 6.5% (p=0.04), 6.5% vs. 7.6% (p=0.52) and 13.5% vs. 11.0% (p=0.40) in the <3%, 3-5%, and ≥5% STS score strata, respectively.Conclusions: Among patients at intermediate surgical risk but with an STS PROM <3%, TAVI may achieve superior clinical outcomes compared to SAVR. These findings support the need for an adequately powered randomised trial to compare TAVI with SAVR in patients at low operative risk.

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“…1 - 5 The incidence of moderate or severe PVL following TAVI varies from 0% to 24% and that of mild PVL from 7% to 70%. 6 BPD is performed in 21% to 28% of cases with the first generation THVs.…”

Section: Introductionmentioning

confidence: 99%

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Miyazaki¹,

Modolo²,

Abdelghani³

et al. 2018

Arquivos Brasileiros De Cardiologia

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BackgroundBalloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes.ObjectiveTo investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD.MethodsVideodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases.ResultsVD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p < 0.05 defined the statistical significance). The relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD.ConclusionsVD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

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Transcatheter Aortic Valve Implantation in Lower-Risk Patients With Aortic Stenosis

Cited by 10 publications

References 172 publications

Predicting Mortality After Transcatheter Aortic Valve Replacement

Predicting Mortality After Transcatheter Aortic Valve Replacement

One-year outcomes of patients with severe aortic stenosis and an STS PROM of less than three percent in the SURTAVI trial

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

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