TCT CONNECT-132 The Relationship Between Eccentricity Index and Hemodynamic Performance in Patients Undergoing Transcatheter Aortic Valve Replacement With Balloon Expandable Valve

BackgroundThere has been rapid growth in the demand for transcatheter aortic valve replacement (TAVR), which has the potential to overwhelm current capacity. This imbalance between demand and capacity may lead to prolonged wait times, and subsequent adverse outcomes while patients are on the waitlist. We sought to understand the relationship between regional differences in capacity, TAVR wait times and morbidity/mortality on the waitlist.Methods and resultsWe modelled the effect of TAVR capacity, defined as the number of TAVR procedures per million residents/region, on the hazard of having a TAVR in Ontario from April 2012 to March 2017. Our primary outcome was the time from referral to a TAVR procedure or other off-list reasons on the waitlist/end of the observation period as measured in days. Clinical outcomes of interest were all-cause mortality, all-cause hospitalisations or heart failure-related hospitalisations while on the waitlist for TAVR. There was an almost fourfold difference in TAVR capacity across the 14 regions in Ontario, ranging from 31.5 to 119.5 TAVR procedures per million residents. The relationship between TAVR capacity and wait times was complex and non-linear. In general, increased capacity was associated with shorter wait times (p<0.001), reduced mortality (HR 0.94; p=0.08) and all-cause hospitalisations (p=0.009).ConclusionsThe results of the present study have important policy implications, suggesting that there is a need to improve TAVR capacity, as well as develop wait-time strategies to triage patients, in order to decrease wait times and mitigate the hazard of adverse patient outcomes while on the waitlist.

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The Relationship of Dialysis Risk and Transcatheter Aortic Valve Replacement From the UK TAVI Registry

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2017.05.061 ◽

2017 ◽

Vol 10 (20) ◽

pp. 2048-2049

Author(s):

Anand Prasad ◽

Marlene Garcia

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Transcatheter Aortic Valve ◽

The Uk ◽

Relationship Of ◽

The Relationship

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Rate, correlates, and outcomes of hemodynamic valve deterioration after transcatheter aortic valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehab724.2190 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C Nitsche ◽

D M Mutschlechner ◽

M K Koschutnik ◽

C D Dona ◽

V D Dannenberg ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Cox Regression ◽

Academic Research ◽

Outcome Analysis ◽

Aortic Valves ◽

Transcatheter Aortic Valve ◽

Hemodynamic Performance

Abstract Objectives Treatment expenditure of transcatheter aortic valve replacement (TAVR) to younger individuals may potentially be limited by valve durability. Long-term hemodynamic performance of transcatheter aortic valves is not well documented. This study sought to determine the incidence, predisposing factors and outcomes of hemodynamic valve deterioration (HVD) after TAVR. Methods Consecutive patients undergoing TAVR between May 2007 and December 2018 (67.0% Sapien, 14.6% Evolut, 6.8% Acurate, 6.8% Portico, 4.8% other) were prospectively studied. Baseline assessment included echocardiography, laboratory, and clinical assessment. Echocardiographic and laboratory follow-up after TAVR was performed prior to discharge, at 3 and 12 months, and yearly thereafter. HVD was defined by Doppler assessment according to Valve Academic Research Consortium 3 criteria as a ≥10 mm Hg increase in mean gradient to ≥20 mm Hg OR worsening of (para-)prosthetic regurgitation ≥1/3 class to ≥moderate. The primary endpoint was the incidence of HVD. All-cause mortality served as secondary endpoint. Multivariate cox regression was used for outcome analysis. Results 649 patients (82.2±6.7 y/o, 55.5% female, EuroSCORE II 4.4±1.0) were analyzed. Among survivors with available echo data from ≥2 follow-ups (n=382), the incidence of HVD was 6.8% (n=26; 4.1% per valve-year), with no difference between valve types. Modes of HVD were stenosis (n=8), regurgitation (n=14), and both (n=4). Median time to HVD was 14.2 months (interquartile range, 9.4 to 35.0 months), and was significantly shorter in patients in the highest age quartile (Q4 vs. Q1–3: log-rank, p<0.01, Figure). Also, increased age was the only factor that independently predisposed for HVD (Q4 vs. Q1–3: adjusted hazard ratio [adj HR]: 2.86, 95% confidence interval [CI]: 1.30–6.30, p<0.01). Following TAVR, 355 patients (54.7%) had died after 64.2±31.9 months. Independent predictors of mortality were (para-)prosthetic regurgitation >mild at discharge (HR: 1.58, 95% CI: 1.21–2.06, p<0.001), male sex (HR: 1.57, 95% CI: 1.24–2.00, p<0.001), baseline NT-proBNP serum levels (graded into quartiles, HR: 1.31, 95% CI: 1.17–1.46, p<0.001), and diabetes (HR: 1.38, 95% CI: 1.08–1.76, p=0.011), but not time-dependent HVD (p>0.05, Figure). Conclusion This study reports good hemodynamic performance of transcatheter aortic valves up to 8 years following intervention. The incidence of HVD, which may develop over time – especially in the elderly –, is low and does not impact survival. Conversely, (para-)prosthetic regurgitation early after TAVR conveys detrimental prognostic implications and needs to be avoided – particularly in younger patients. FUNDunding Acknowledgement Type of funding sources: None. Hemodynamic valve deterioration in TAVR

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Abstract 18892: Clinical and Hemodynamic Factors Influence the Risk of Pulmonary Hypertension in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the PARTNER I Trial and Registry

Circulation ◽

10.1161/circ.130.suppl_2.18892 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Brian R Lindman ◽

Alan Zajarias ◽

Hersh Maniar ◽

Rakesh M Suri ◽

D. Craig Miller ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Renal Function ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Hemodynamic Variable ◽

Transcatheter Aortic Valve ◽

The Relationship

Introduction: Pulmonary hypertension (PH) is associated with increased mortality after surgical or transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). Hypothesis: We hypothesized that clinical or hemodynamic factors might influence the relationship between significant PH and increased mortality. Methods: Among patients with symptomatic AS at high or prohibitive surgical risk receiving TAVR in the PARTNER I randomized trial or registry, 2180 patients with an invasive measurement of mean pulmonary artery pressure (mPAP) recorded were included. PH was defined as: none (mPAP<25 mmHg), mild (25 to <35), and mod/sev (≥35). Results: One year all-cause mortality was worse with increasing severity of PH: none (n=785, 18.6%), mild (n=838, 22.7%), and mod/sev (n=557, 25.0%) (p=0.01). The association between mod/sev PH (vs. no PH) and 1y mortality varied by sex and renal function (interaction p=0.03 and p=0.06, respectively). In females, mod/sev PH was associated with increased mortality (24.6% vs. 14.1%, HR 1.89, 95% CI 1.32-2.73); in males it was not (24.9% vs. 22.2%, HR 1.12, 95% CI 0.82-1.52). Additionally, mod/sev PH was associated with mortality in those with glomerular filtration rate (GFR) <40 (HR 1.76, 95% CI 1.28-2.42), but not in those with GFR ≥40. In a multivariable Cox PH model of patients with mod/sev PH, oxygen dependent lung disease, cerebrovascular disease, lower GFR, and lower baseline transvalvular mean gradient were each independently associated with increased 1y mortality (p<0.05 for all), whereas pulmonary artery compliance was the only hemodynamic variable associated with mortality (p=0.043) (Table). Conclusions: The relationship between mod/sev PH and increased mortality after TAVR is altered by sex and renal function. While lower pulmonary artery compliance is associated with increased mortality in patients with significant PH, clinical factors appear to be more influential in stratifying risk than hemodynamic indices.

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