TCT-417 Long-term mortality of patients undergoing transcatheter aortic valve replacement for bicuspid versus tricuspid aortic stenosis

Abstract Although it is well known, the differences between both sexes in cardiovascular disease, however, there is a lack of data in aortic valve, treated with Transcatheter Aortic Valve Replacement (TAVR). The purpose of our study was to analyze the long-term clinical results of patients treated with TAVR in the female and male population. Material Between April 2008 and December 2017, 647 patients with aortic stenosis and 20 patients with aortic prosthesis dysfunction, were treated with TAVR consecutively in our center. The primary objective was to analyze, by Cox regression, the predictors of long-term mortality in both sexes. Results 59.1% were women. Males had a higher number of comorbidities and after a mean follow-up of 2.87±2.2 years (range between 0 and 9 years), mortality was higher for male patients 40.7% vs. 32% (HR = 1.447 [95% CI 1.057–2.009], p=0.022) and there were no differences for the presence of threatening bleeding (HR = 1.654 [IC95% 0.719–3.808], p=0.237), myocardial infarction (HR = 1,768 [IC95% 0.753–4.132], p=0.191), stroke (HR = 0.992 [IC95% 0.564–1.743], p=0.976) and hospitalizations for heart failure (HR = 1.388 [IC95% 0.811–2.376], p=0.231). Among the predictors of long-term mortality, common to both sexes were: threatening bleeding, heart failure, Charlson index, Karnofsky, and STS score. Conclusion In our series, there was clinical differences between both sexes, which has an impact on survival, being worse for men due to comorbidities, however, in the population of patients with aortic stenosis treated with TAVI, we found predictors of late mortality similarities between in female and male.

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Abstract 15741: Long Term Survival Following Transcatheter Aortic Valve Replacement: Results From a Single US High Volume Center

Circulation ◽

10.1161/circ.130.suppl_2.15741 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ricardo O Escarcega ◽

Rebecca Torguson ◽

Marco A Magalhaes ◽

Nevin C Baker ◽

Sa’ar Minha ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Term Survival ◽

Transcatheter Aortic Valve ◽

Significant Difference ◽

Long Term Mortality

Introduction: Mortality following Transcatheter aortic valve replacement (TAVR) has been reported up to 5 years. However, mortality after 5 years remains unclear. Hypothesis: We aim to determine the mortality in patients undergoing TAVR >5 years follow up. Methods: From our institution’s prospectively collected TAVR database we analyzed all patients undergoing TAVR to a maximum follow up of 8 years. We divided our population into transapical TAVR (TA-TAVR) and transfemoral TAVR (TF-TAVR) groups. A Kaplan-Meier survival analysis was conducted. Results: A total of 511 patients who underwent TAVR were included in the analysis. Patients undergoing TA-TAVR had higher rates of peripheral vascular disease compared with TF-TAVR (56% vs 29%, p<0.001) and Society of Thoracic Surgeons Score (10.9 ± 4 vs 9.2 ± 4, p<0.001). TA-TAVR was associated with higher mortality at 1 year (32% vs 21%, p=0.01). However, there was no significant difference in very-long term mortality of patients undergoing TA-TAVR vs TF-TAVR (Figure). Conclusions: Long-term mortality following TAVR surpasses 50%. While in the first 2 years TA-TAVR is associated with higher mortality rates after three years the survival rates are similar in both approaches.

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Prognosis of persistent mitral regurgitation in patients undergoing transcatheter aortic valve replacement

Clinical Research in Cardiology ◽

10.1007/s00392-020-01618-9 ◽

2020 ◽

Vol 109 (10) ◽

pp. 1261-1270 ◽

Cited By ~ 1

Author(s):

Victor Mauri ◽

Maria I. Körber ◽

Elmar Kuhn ◽

Tobias Schmidt ◽

Christian Frerker ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Severe Aortic Stenosis ◽

Transcatheter Aortic Valve ◽

The Impact

Abstract Objective The objective of this study was to assess imaging predictors of mitral regurgitation (MR) improvement and to evaluate the impact of MR regression on long-term outcome in patients undergoing transcatheter aortic valve replacement (TAVR). Background Concomitant MR is a frequent finding in patients with severe aortic stenosis but usually left untreated at the time of TAVR. Methods Mitral regurgitation was graded by transthoracic echocardiography before and after TAVR in 677 consecutive patients with severe aortic stenosis. 2-year mortality was related to the degree of baseline and discharge MR. Morphological echo analysis was performed to determine predictors of MR improvement. Results 15.2% of patients presented with baseline MR ≥ 3 +, which was associated with a significantly decreased 2-year survival (57.7% vs. 74.4%, P < 0.001). MR improved in 50% of patients following TAVR, with 44% regressing to MR ≤ 2 +. MR improvement to ≤ 2 + was associated with significantly better survival compared to patients with persistent MR ≥ 3 +. Baseline parameters including non-severe baseline MR, the extent of mitral annular calcification and large annular dimension (≥ 32 mm) predicted the likelihood of an improvement to MR ≤ 2 +. A score based on these parameters selected groups with differing probability of MR ≤ 2 + post TAVR ranging from 10.5 to 94.4% (AUC 0.816; P < 0.001), and was predictive for 2-year mortality. Conclusion Unresolved severe MR is a critical determinant of long term mortality following TAVR. Persistence of severe MR following TAVR can be predicted using selected parameters derived from TTE-imaging. These data call for close follow up and additional mitral valve treatment in this subgroup. Graphic abstract Factors associated with MR persistence or regression after TAVR

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