0087: Progressive increase in ventriculo-arterial impedance is associated with LV disfunction and adverse outcomes in patients with severe aortic stenosis

Background: Surgical aortic valve replacement (SAVR) is associated with adverse outcomes in patients with radiation-associated aortic stenosis. Transcatheter aortic valve replacement (TAVR) may improve outcomes in this population. Methods: We evaluated 1668 TAVR and 2611 patients with SAVR enrolled in the Society of Thoracic Surgeons’ database between 2011 and 2018. Multiple logistic regression was used to compare 30- day outcomes between TAVR and SAVR. Propensity-matched analysis was performed to confirm results of the overall cohort. Additionally, the cohort was stratified into early (2011–2014) versus contemporary (2015–2018) TAVR eras, and 30-day outcomes for TAVR and SAVR were compared. Finally, outcomes with transfemoral TAVR versus SAVR were compared. Results: In the overall cohort, TAVR was associated with significantly reduced 30-day mortality (odds ratio [OR] TAVR/SAVR =0.60 [0.40–0.91]). Postoperative atrial fibrillation, pneumonia, pleural effusion, renal failure, and bleeding also occurred less frequently with TAVR. Stroke/transient ischemic attack (TIA; OR TAVR/SAVR , 2.03 [1.09–3.77]) and pacemaker implantation (OR TAVR/SAVR , 1.62 [1.21–2.17]) were higher with TAVR. Propensity-matched analysis yielded similar results as the overall cohort. Following stratification by era, TAVR versus SAVR was associated with reduced 30-day mortality in the contemporary but not early era (OR Early , 0.78 [0.48–1.28]; OR Contemporary , 0.31 [0.14–0.65]). Pacemaker implantation was higher with TAVR versus SAVR in both eras (OR Early , 1.60 [1.03–2.46]; OR Contemporary , 1.64 [1.10–2.45]). There was also a nonsignificant trend towards increased stroke/TIA with TAVR during both eras (OR Early , 1.39 [0.58–3.36]; OR Contemporary , 2.46 [0.99–6.10]). Finally, transfemoral TAVR (N=1369) versus SAVR revealed similar findings as the overall cohort; however, the association of TAVR with stroke/TIA was not statistically significant (OR Stroke/TIA , 1.57 [0.79–3.09]). Conclusions: TAVR provides an effective and evolving alternative to SAVR for radiation-associated severe aortic stenosis and was associated with lower 30-day mortality and postoperative complications. TAVR was associated with increased pacemaker implantation and a trend towards increased stroke/TIA. In this unique population with extensive valvular and vascular calcifications, the risk of stroke/TIA with TAVR requires careful consideration and further investigation.

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Heartbeat: markers of adverse outcomes in adults with severe aortic stenosis

Heart ◽

10.1136/heartjnl-2020-317201 ◽

2020 ◽

Vol 106 (11) ◽

pp. 785-787

Author(s):

Catherine M Otto

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Adverse Outcomes

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RISK OF ADVERSE OUTCOMES IN TREATMENT MODALITIES FOR SEVERE AORTIC STENOSIS IN RANDOMIZED CONTROL TRIALS: DIRECT AND INDIRECT COMPARISONS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34698-3 ◽

2017 ◽

Vol 69 (11) ◽

pp. 1309

Author(s):

Navkaranbir S. Bajaj ◽

Garima Arora ◽

Nirav Patel ◽

Rajat Kalra ◽

Shikhar Vohra ◽

...

Keyword(s):

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Adverse Outcomes ◽

Treatment Modalities ◽

Randomized Control Trials ◽

Randomized Control ◽

Indirect Comparisons

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P6477Preoperative renal injury and multi-elevated biomarkers are associated with adverse outcomes in patients with severe aortic stenosis undergoing surgical valve replacement

European Heart Journal ◽

10.1093/eurheartj/ehz746.1068 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Spampinato ◽

R Bochen ◽

G Stoeger ◽

F Sieg ◽

T Noack ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Valve Replacement ◽

Renal Injury ◽

Severe Aortic Stenosis ◽

Adverse Outcomes ◽

Amino Terminal ◽

All Cause Mortality

Abstract Background The presence of early stages of renal injury (AKI) and biomarkers has been associated with adverse outcomes in cardiac surgery. Purpose We aimed to determine whether preoperative AKI is associated with long-term all-cause mortality in patients with severe aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) and if the combination of AKI with multi-elevated biomarkers (Amino-terminal pro-B-type natriuretic peptide, BNP; high-sensitivity cardiac troponin T, hsTNT; and C reactive protein, CRP) has a better prognostic utility. Method From a prospective registry of patients with AS referred for SAVR, 560 participants (68±8.8 years; 329 men) were retrospectively included when echocardiograms, serum creatinine and biomarkers were available within 30-days before surgery. Kaplan-Meier (KM) curves for all-cause mortality were created for groups of patients based on the presence of AKI, defined as a stage I or more according to the Acute Kidney Injury Network classification. To further describe the utility of multi-elevated biomarkers, 4 groups were created and the KM-curves and c-statistics evaluated. Mean follow-up was 737±410 days and 30 (5.4%) patients died. Results Patients with preoperative AKI (n=68) were significantly older (70±7.6 vs. 67±8.9 years, p=0.02), more likely to have hypertension, diabetes, a worse functional class (NYHA III-IV: 59% vs. 36%, p<0.001), worse glomerular filtration rate (60±20 vs. 81±26, p<0.001), an elevation of multiple biomarkers (hsTNT, BNP, and CRP), and a higher logistic-EuroScore (3.8±2.8 vs. 3.0±2.2, p=0.04). But there were no differences in the incidence of coronary artery disease, LVEF (57±10 vs. 59±11%), aortic valve area index, or in surgical characteristics. Those patients with AKI exhibited higher 3-year all-cause mortality (11.7% vs. 5.7%, p=0.04). Interestingly, the combination of AKI with 3 elevated biomarkers was associated with a more than fourfold increase in 3-year all-cause mortality (47.5% vs. 4.3%, p<0.0001), and the c-statistics (AUC 0.599 vs 0.710, p<0.001) suggested a better prediction for long-term death. Figure 1 Conclusions This study demonstrates an adverse association of preoperative AKI with survival following SAVR, which was accentuated when combined with multi-elevated biomarkers, suggesting the need for less invasive strategies and/or closer postoperative follow–up in such patients.

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Prognostic Impact of Myocardial Extracellular Volume Fraction Assessment Using Dual‐Energy Computed Tomography in Patients Treated With Aortic Valve Replacement for Severe Aortic Stenosis

Journal of the American Heart Association ◽

10.1161/jaha.120.020655 ◽

2021 ◽

Author(s):

Masataka Suzuki ◽

Takayoshi Toba ◽

Yu Izawa ◽

Hiroshi Fujita ◽

Keisuke Miwa ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Volume Fraction ◽

Independent Predictor ◽

Severe Aortic Stenosis ◽

Extracellular Volume ◽

Extracellular Volume Fraction ◽

Dual Energy ◽

Adverse Outcomes ◽

Dual Energy Ct

Background Myocardial extracellular volume fraction (ECV), measured by cardiac magnetic resonance imaging, is a useful prognostic marker for patients who have undergone aortic valve replacement (AVR) for aortic stenosis. However, the prognostic significance of ECV measurements based on computed tomography (CT) is unclear. This study evaluated the association between ECV measured with dual‐energy CT and clinical outcomes in patients with aortic stenosis who underwent transcatheter or surgical AVR. Methods and Results We retrospectively enrolled 95 consecutive patients (age, 84.0±5.0 years; 75% women) with severe aortic stenosis who underwent preprocedural CT for transcatheter AVR planning. ECV was measured using iodine density images obtained by delayed enhancement dual‐energy CT. The primary end point was a composite outcome of all‐cause death and hospitalization for heart failure after AVR. The mean ECV measured with CT was 28.1±3.8%. During a median follow‐up of 2.6 years, 22 composite outcomes were observed, including 15 all‐cause deaths and 11 hospitalizations for heart failure. In Kaplan‐Meier analysis, the high ECV group (≥27.8% [median value]) had significantly higher rates of composite outcomes than the low ECV group (<27.8%) (log‐rank test, P =0.012). ECV was the only independent predictor of adverse outcomes on multivariable Cox regression analysis (hazards ratio, 1.25; 95% CI, 1.10‒1.41; P <0.001). Conclusions Myocardial ECV measured with dual‐energy CT in patients who underwent aortic valve intervention was an independent predictor of adverse outcomes after AVR.

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