EFFECT OF SEVERE LEFT VENTRICULAR DYSFUNCTION ON OUTCOMES AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT VERSUS SURGICAL AORTIC VALVE REPLACEMENT: A PROPENSITY SCORE REGRESSION ANALYSIS

Abstract High-sensitivity Troponin (hs-Tn) has emerged as a useful marker for patients with myocardial injury or heart failure. However, few studies have compared intermediate and hs-Tn in patients undergoing transcatheter aortic valve replacement (TAVR). Moreover, there remains uncertainty of which thresholds are the most useful for discriminating ventricular dysfunction or outcome. In this study we prospectively enrolled 105 patients with severe aortic stenosis (AS) who underwent TAVR as well as blood sampling for high-sensitivity (hs-TnI) and conventional troponin I (EXL-LOCI and RXL) assessment. Patients underwent comprehensive pre-procedure echocardiography. Ventricular dysfunction was defined using left ventricular mass index (LVMI), LV global longitudinal strain (LVGLS) and LV end-diastolic pressure. The mean age was 84.0 ± 8.7 years old and 60% were male sex with mean transaortic pressure gradient of 50.1 ± 16.0 mmHg and AVA of 0.63 ± 0.19 cm2. When using a threshold of 6 ng/L, 77% had positive hs-TnI while 27% had positive hs-TnI using recommended thresholds (16 ng/L for female and 34 ng/L for male). Troponin levels were higher in the presence of abnormal LV phenotypes. The strongest correlate of troponin was LVMI. During median follow-up of 375 days, 21 patients (20%) died. Lower threshold of hs-TnI and EXL-TnI was more discriminatory for overall mortality (Log-rank P = 0.03 for both), while higher threshold of hs-TnI (p = 0.75) and RXL-TnI were not (p = 0.30). Combining hs-TnI and BNP improved to predict long-term outcome (p = 0.004). In conclusion, hs-TnI levels correlated with the degree of LV dysfunction phenotypes. Furthermore, applying a lower threshold for hs-TnI performed better for outcome prediction than a recommended threshold in patients undergoing TAVR. Combining hs-TnI with BNP helped better risk stratification.

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Transcatheter Aortic Valve Replacement: Comprehensive Review and Present Status

Texas Heart Institute Journal ◽

10.14503/thij-16-5852 ◽

2017 ◽

Vol 44 (1) ◽

pp. 29-38 ◽

Cited By ~ 19

Author(s):

Sameer Arora ◽

Jacob A. Misenheimer ◽

Radhakrishnan Ramaraj

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

The United States ◽

Left Ventricular ◽

Severe Left Ventricular Dysfunction ◽

Surgical Risk ◽

Transcatheter Aortic Valve

Aortic stenosis is the most common valvular heart disease in the developed world. About 7% of the population over age 65 years suffers from degenerative aortic stenosis. The prognosis of patients with symptomatic severe aortic stenosis is dismal without valve replacement. Even though the American College of Cardiology recommends aortic valve replacement to treat this condition as a class I recommendation, approximately one third of these patients over the age of 75 years are not referred for surgery. Typically, this is from concern about prohibitive surgical risk associated with patient frailty, comorbidities, age, and severe left ventricular dysfunction. The advent in France of transcatheter aortic valve replacement has raised the hope in the United States for an alternative, less invasive treatment for aortic stenosis. Two recent trials—the Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve (Partner) and the CoreValve US Pivotal—have established transcatheter aortic valve replacement as the preferred approach in patients who are at high or prohibitive surgical risk. The more recently published Partner 2 trial has shown the feasibility of transcatheter aortic valve replacement in intermediate-surgical-risk patients as well. With a profile that promises easier use and better valve performance and delivery, newer-generation valves have shown their potential for further improvement in safety profile and overall outcomes. We review the history and status of this topic.

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Impact of Left Ventricular Dysfunction in Patients with High and Low Gradient Severe Aortic Stenosis Following Transcatheter Aortic Valve Replacement

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2020.10.014 ◽

2020 ◽

Author(s):

Julien Ternacle ◽

Laurent Faroux ◽

Alberto Alperi ◽

Guillem Muntané-Carol ◽

Robert Delarochellière ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Transcatheter Aortic Valve

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Impact of new pacemaker implantation following surgical and transcatheter aortic valve replacement on 1-year outcome

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz168 ◽

2019 ◽

Vol 57 (1) ◽

pp. 151-159 ◽

Cited By ~ 7

Author(s):

Buntaro Fujita ◽

Tobias Schmidt ◽

Sabine Bleiziffer ◽

Timm Bauer ◽

Andreas Beckmann ◽

...

Keyword(s):

Regression Analysis ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Cox Regression ◽

Pacemaker Implantation ◽

Surgical Aortic Valve Replacement ◽

Cox Regression Analysis ◽

Transcatheter Aortic Valve

Abstract OBJECTIVES The purpose of this study was to evaluate the incidence of new pacemaker implantation (NPMI) after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR), and investigate its influence on 1-year mortality. METHODS Patients who were enrolled in ‘The German Aortic Valve Registry’ undergoing isolated TAVR or SAVR between 2011 and 2015 were analysed. The rate of NPMI was analysed for both groups and multivariable Cox regression analysis was performed to investigate the possible independent association between NPMI and 1-year mortality. RESULTS Twenty thousand eight hundred and seventy-two patients who underwent TAVR and 17 750 patients who received SAVR were included in this study. The rate of NPMI was 16.6% after TAVR and 3.6% after SAVR. In the TAVR group, NPMI was associated with significantly increased 1-year mortality in univariable Cox regression analysis [hazard ratio (HR) 1.29, confidence interval (CI) 1.18–1.41; P < 0.001]. This association persisted after adjustment for confounding factors (HR 1.29, CI 1.16–1.43; P < 0.001). In the SAVR group, NPMI significantly increased 1-year mortality in univariable analysis as well (HR 1.55, CI 1.08–2.22; P = 0.02), whereas after multivariable adjustment, NPMI did not emerge as an independent risk factor (HR 1.29, 0.88–1.89; P = 0.19). NPMI was not associated with 30-day mortality in both procedure groups. CONCLUSIONS The rate of NPMI was markedly higher after TAVR compared with SAVR and was independently associated with 1-year mortality after TAVR, whereas this was not significant after SAVR. As 30-day mortality was not different for TAVR and SAVR, the subsequent procedure of an NPMI itself seems not to increase the risk of mortality.

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Transcatheter aortic valve replacement and His bundle pacing in the presence of severe left ventricular dysfunction and left bundle branch block

Journal of Transcatheter Interventions ◽

10.31160/jotci202129a20210006 ◽

2021 ◽

Vol 29 ◽

pp. 1-4

Author(s):

Luiz São Thiago ◽

Luis Luciano ◽

Aline Tscha ◽

Artur Guimarães ◽

Alice Silva ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Bundle Branch Block ◽

Transcatheter Aortic Valve Replacement ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Bundle Branch Block ◽

Transcatheter Aortic Valve

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (>75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.

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