CRT-400.32 The Impact of Frailty on Long-Term Outcome in Patients Undergoing Transcatheter Aortic Valve Replacement

The aim of this study was to compare patients with transcatheter aortic valve replacement (TAVR) receiving new generation prostheses SAPIEN 3 (S3, Edwards Lifesc.) and Evolut R (ER, Medtronic Inc.) in terms of periprocedural and long-term outcome. Our retrospective, single-center analysis included 359 consecutive patients with severe aortic stenosis who underwent TAVR with S3 or ER from 2014–2016 (mean age 82 ± 7 years, 47% male, mean EuroSCORE II 8.0 ± 8%, mean follow-up 3.8 years). Device Success was equal (S3 93.0% vs. ER 92.4%, p = 0.812). We report a 30-day mortality of 2.8% in the S3 group, and 2.1% in the ER group (p = 0.674). There was no difference in stroke, conversion to open surgery, vascular and bleeding complications or myocardial infarction. While prosthesis mean gradients were higher with S3 (12.0 mmHg vs. 8.2 mmHg, p < 0.001), there was a trend to less paravalvular regurgitation (PVR moderate or severe: 1% vs. 3.6%, p = 0.088). All-cause mortality up to 5 years did not show a difference (mean survival S3 3.5 ± 0.24 years, ER 3.3 ± 0.29 years, p = 0.895). Independent predictors of long-term mortality were impaired LVEF, chronic kidney injury, peripheral artery disease, malignant tumor and periprocedural stroke. New generation TAVR valves offer an excellent implant and outcome success rate. Long-term survival was independent of prostheses choice and mainly attributed to comorbidities and complications.

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Faculty Opinions recommendation of Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.738284985.793576874 ◽

2020 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Term Outcome ◽

Long Term Outcome ◽

Transcatheter Aortic Valve

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Long-term outcome of prosthesis-patient mismatch after transcatheter aortic valve replacement

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.06.033 ◽

2020 ◽

Vol 318 ◽

pp. 27-31

Author(s):

Miriam Compagnone ◽

Giulia Marchetti ◽

Nevio Taglieri ◽

Gabriele Ghetti ◽

Antonio Giulio Bruno ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Term Outcome ◽

Long Term Outcome ◽

Transcatheter Aortic Valve

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Transcatheter Aortic Valve Replacement in Lebanon: Population and Procedural Characteristics and Long-term Outcome – A Single Center Experience

10.37191/mapsci-jccr-2(1)-023 ◽

2021 ◽

Author(s):

Antonio H. Frangieh

Keyword(s):

Middle East ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Cardiovascular Mortality ◽

Transcatheter Aortic Valve Replacement ◽

Single Center ◽

Long Term Outcome ◽

Transcatheter Aortic Valve

Background: Transcatheter aortic valve replacement (TAVR) programs are growing in the Middle East, but data on treated patients in this region is scarce. We sought in this study to analyze the largest single-center population in Lebanon. Methods and Results: Baseline clinical, procedural characteristics as well as in-hospital and up to five years follow-up outcomes were collected and analyzed for the 141 patients (80 ± 7 years, 51.8% females) included between 2014 and 2019. All-cause mortality at 30 days found in 5 (3.5%) cases was considered as the primary endpoint while Major Adverse Cardiovascular Events at 30 days as secondary ones: cardiovascular mortality in 3 cases (2.1%), strokes in 1 case (0.7%), percutaneous coronary intervention in 3 cases (2.1%) and myocardial infarction in 3 cases (2.1%). Device success and intended prosthesis performance were achieved in 119 (84.4%) and 121 (85.8%) patients, respectively. Multivariate analysis showed that cardiovascular mortality is strongly associated with end-stage renal failure and peripheral artery disease. The dichotomization of patients into two cohorts A and B corresponding to the first and second 3 years of the TAVR time interval showed slow evolution of TAVR patients to a younger and lower risk population but maintained good results. Conclusion: TAVR in Lebanon shows satisfactory results and good long-term outcomes. Data from the regional prospective registry is needed to assess the evolution of this therapy in the middle-east region.

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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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