scholarly journals Propensity score-matched analysis of patients with severe aortic stenosis undergoing surgical aortic valve replacement

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000992 ◽  
Author(s):  
Shiro Miura ◽  
Takehiro Yamashita ◽  
Michiya Hanyu ◽  
Hiraku Kumamaru ◽  
Shinichi Shirai ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Propensity Score ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Cardiovascular Events ◽  
Severe Aortic Stenosis ◽  
Surgical Aortic Valve Replacement ◽  
Asymptomatic Patients ◽  
All Cause Mortality ◽  
Baseline Characteristics

ObjectiveSevere aortic stenosis (AS) is one of the most serious valve conditions. Patient demography and the aetiology of AS have substantially changed in the past several decades along with a drastic improvement of surgical aortic valve replacement (SAVR) and its associated procedures. Contemporary patients with severe AS have multiple comorbidities and live much longer. We aimed to elucidate the treatment effects of SAVR on long-term outcome in propensity score (PS)-matched and the entire patient populations.MethodsWe retrospectively reviewed 570 patients with severe AS defined as an aortic valve area of 1.0 cm2 or less. Systemic differences in 39 baseline characteristics between non-SAVR and SAVR groups were adjusted using PS matching method. The endpoints included all-cause mortality and cardiovascular events that included heart failure, non-fatal stroke, syncope and acute coronary syndrome.ResultsOverall, 55% of the entire population (mean age 78 years; males 41%) were symptomatic. During 3.9 years of the median follow-up, 210 (36%) patients underwent SAVR and 231 (41%) died. Cumulative incidences of mortality and both mortality and cardiovascular events were significantly higher in the non-SAVR group than in the other group (p<0.001, each). Among 101 PS-matched pairs, SAVR correlated with a lower mortality risk (HR 0.35; 95% CI 0.21 to 0.59; p<0.001)) and mortality and cardiovascular events combined (HR 0.62; 95% CI 0.42 to 0.92; p=0.02). However, survival difference between both groups was markedly smaller among asymptomatic patients in the subgroup of matched patients.ConclusionPatients with AS undergoing SAVR exhibit a lower incidence of all-cause mortality and major cardiovascular events than those not undergoing surgical interventions, even after the baseline characteristics are balanced by the PS matching. The correlation between SAVR and survival from cardiovascular events is less evident among asymptomatic patients.

scholarly journals Early Aortic Valve Replacement vs. Conservative Management in Asymptomatic Severe Aortic Stenosis Patients With Preserved Ejection Fraction: A Meta-Analysis

2021 ◽  
Vol 7 ◽  
Author(s):  
Tan Yuan ◽  
Yi Lu ◽  
Chang Bian ◽  
Zhejun Cai
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Aortic Valve Replacement ◽  
Conservative Management ◽  
Severe Aortic Stenosis ◽  
Preserved Ejection Fraction ◽  
Cardiac Mortality ◽  
Asymptomatic Patients ◽  
All Cause Mortality

Background: Aortic stenosis (AS) is the most common valvular disease in developed countries. Until now, the specific timing of intervention for asymptomatic patients with severe aortic stenosis and preserved ejection fraction remains controversial.Methods: A systematic search of four databases (Pubmed, Web of science, Cochrane library, Embase) was conducted. Studies of asymptomatic patients with severe AS or very severe AS and preserved left ventricular ejection fraction underwent early aortic valve replacement (AVR) or conservative care were included. The end points included all-cause mortality, cardiac mortality, and non-cardiac mortality.Results: Four eligible studies were identified with a total of 1,249 participants. Compared to conservative management, patients who underwent early AVR were associated with lower all-cause mortality, cardiac mortality, and non-cardiac mortality rate (OR 0.16, 95% CI 0.09–0.31, P &lt; 0.00001; OR 0.12, 95% CI 0.02–0.62, P = 0.01; OR 0.36, 95% CI 0.21–0.63, P = 0.0003, respectively).Conclusions: Early AVR is preferable for asymptomatic severe AS patients with preserved ejection fraction.

Abstract 17367: Propitious Temporal Changes in Clinical Outcomes After Transcatheter Compared to Surgical Aortic Valve Replacement; A Meta-Analysis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ankur Panchal ◽  
Andreas Kyvernitakis ◽  
Mark Doyle ◽  
Robert W Biederman
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Meta Analysis ◽  
Temporal Changes ◽  
Surgical Aortic Valve Replacement ◽  
All Cause Mortality

Introduction: Treatment for severe aortic stenosis has rapidly evolved over the past decade, in both transcatheter aortic valve replacement (TAVR) technique and surgical aortic valve replacement (SAVR), resulting in improved clinical outcomes. We sought to determine and compare the temporal changes and 1-year outcomes between these groups. Methods: We searched the Medline MESH database using the keywords “aortic stenosis”, “atrial fibrillation” and “stroke”. We performed a meta-analysis and created funnel plots to compare TAVR with SAVR population for post-procedural stroke, all-cause and cardiovascular (CV) mortality at 1-year. Results: Out of >50 studies, we included 20 meeting criteria for analysis with total population of >65000 patients, of which 61067 had TAVR and 4162 had SAVR. AFib prevalence was higher in TAVR vs SAVR patients (38% vs 27%; p< 0.0001). By funnel plotting, post-procedural stroke at 1-year was 3.1% in TAVR and 5% in SAVR patients (NS). All-cause mortality at 1 year was 12.5% in TAVR and 10.3 % in SAVR patients, and CV mortality at 1-year was 7.4% in TAVR and 6.2% in SAVR patients (NS for both). Conclusion: While there is a trend over the last 14 years for overall improvement in both SAVR and TAVR outcomes, via meta-analysis, despite a higher prevalence of AFib in TAVR vs SAVR, there is statistical overlap in the confidence intervals supporting no distinct separation in stroke risk, all-cause mortality or adjudicated CV mortality at 1 year between groups. To our knowledge, this represents the largest study over the longest time period that points towards potential benefit at the individual level but as a socio-economic consideration, no distinction between SAVR vs TAVR.

scholarly journals Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Charbel Abi Khalil ◽  
Barbara Ignatiuk ◽  
Guliz Erdem ◽  
Hiam Chemaitelly ◽  
Fabio Barilli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Randomized Clinical Trials ◽  
Severe Aortic Stenosis ◽  
Paravalvular Leak ◽  
Effective Orifice Area ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

scholarly journals Timing of Intervention in Asymptomatic Patients with Aortic Stenosis

2021 ◽  
Vol 16 ◽  
Author(s):  
Teresa Sevilla ◽  
Ana Revilla-Orodea ◽  
J Alberto San Román
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Perioperative Complications ◽  
Scientific Evidence ◽  
Optimal Timing ◽  
Common Disease ◽  
Asymptomatic Patients

Aortic stenosis is a very common disease. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Continuous advances in both surgical and percutaneous techniques have substantially decreased rates of perioperative complications and mortality; with this in mind, many authors suggest that earlier intervention in patients with severe aortic stenosis, when they are still asymptomatic, may be indicated. This paper summarises what is known about the natural history of severe aortic stenosis and the scientific evidence available about the optimal timing for aortic valve replacement.

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