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Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

Journal of the American College of Cardiology, 2017-12, Vol.70 (22), p.2752-2763 [Peer Reviewed Journal]

2017 American College of Cardiology Foundation ;Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Dec 5, 2017 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2017.10.006 ;PMID: 29191323

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Title:
Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation
Author: Yoon, Sung-Han ; Schmidt, Tobias ; Bleiziffer, Sabine ; Schofer, Niklas ; Fiorina, Claudia ; Munoz-Garcia, Antonio J. ; Yzeiraj, Ermela ; Amat-Santos, Ignacio J. ; Tchetche, Didier ; Jung, Christian ; Fujita, Buntaro ; Mangieri, Antonio ; Deutsch, Marcus-Andre ; Ubben, Timm ; Deuschl, Florian ; Kuwata, Shingo ; De Biase, Chiara ; Williams, Timothy ; Dhoble, Abhijeet ; Kim, Won-Keun ; Ferrari, Enrico ; Barbanti, Marco ; Vollema, E. Mara ; Miceli, Antonio ; Giannini, Cristina ; Attizzani, Guiherme F. ; Kong, William K.F. ; Gutierrez-Ibanes, Enrique ; Jimenez Diaz, Victor Alfonso ; Wijeysundera, Harindra C. ; Kaneko, Hidehiro ; Chakravarty, Tarun ; Makar, Moody ; Sievert, Horst ; Hengstenberg, Christian ; Prendergast, Bernard D. ; Vincent, Flavien ; Abdel-Wahab, Mohamed ; Nombela-Franco, Luis ; Silaschi, Miriam ; Tarantini, Giuseppe ; Butter, Christian ; Ensminger, Stephan M. ; Hildick-Smith, David ; Petronio, Anna Sonia ; Yin, Wei-Hsian ; De Marco, Federico ; Testa, Luca ; Van Mieghem, Nicolas M. ; Whisenant, Brian K. ; Kuck, Karl-Heinz ; Colombo, Antonio ; Kar, Saibal ; Moris, Cesar ; Delgado, Victoria ; Maisano, Francesco ; Nietlispach, Fabian ; Mack, Michael J. ; Schofer, Joachim ; Schaefer, Ulrich ; Bax, Jeroen J. ; Frerker, Christian ; Latib, Azeem ; Makkar, Raj R.
Subjects: Aged ; Aged, 80 and over ; Aorta ; aortic regurgitation ; Aortic valve ; Aortic Valve - surgery ; Aortic Valve Insufficiency - diagnosis ; Aortic Valve Insufficiency - mortality ; Aortic Valve Insufficiency - surgery ; Catheterization, Peripheral - methods ; Catheterization, Peripheral - statistics & numerical data ; Confidence intervals ; Consortia ; Data collection ; Devices ; Electrocardiography ; Female ; Femoral Artery - surgery ; Heart ; Heart Valve Prosthesis - adverse effects ; Heart Valve Prosthesis - standards ; Humans ; Implantation ; International Cooperation ; Laboratories ; Male ; Medical prognosis ; Mortality ; Outcome and Process Assessment (Health Care) ; Patients ; Postoperative Complications - diagnosis ; Postoperative Complications - epidemiology ; Prosthesis Design - trends ; Quality Improvement ; Registries - statistics & numerical data ; Regurgitation ; Review boards ; Risk Assessment ; Severity of Illness Index ; Software ; Studies ; Survival analysis ; Systematic review ; Transcatheter Aortic Valve Replacement - adverse effects ; Transcatheter Aortic Valve Replacement - instrumentation ; Transcatheter Aortic Valve Replacement - methods ; Transcatheter Aortic Valve Replacement - statistics & numerical data ; transcatheter valve implantation
Is Part Of: Journal of the American College of Cardiology, 2017-12, Vol.70 (22), p.2752-2763
Description: Limited data exist about safety and efficacy of transcatheter aortic valve replacement (TAVR) in patients with pure native aortic regurgitation (AR). This study sought to compare the outcomes of TAVR with early- and new-generation devices in symptomatic patients with pure native AR. From the pure native AR TAVR multicenter registry, procedural and clinical outcomes were assessed according to VARC-2 criteria and compared between early- and new-generation devices. A total of 331 patients with a mean STS score of 6.7 ± 6.7 underwent TAVR. The early- and new-generation devices were used in 119 patients (36.0%) and 212 patients (64.0%), respectively. STS score tended to be lower in the new-generation device group (6.2 ± 6.7 vs. 7.6 ± 6.7; p = 0.08), but transfemoral access was more frequently used in the early-generation device group (87.4% vs. 60.8%; p < 0.001). Compared with the early-generation devices, the new-generation devices were associated with a significantly higher device success rate (81.1% vs. 61.3%; p < 0.001) due to lower rates of second valve implantation (12.7% vs. 24.4%; p = 0.007) and post-procedural AR ≥ moderate (4.2% vs. 18.8%; p < 0.001). There were no significant differences in major 30-day endpoints between the 2 groups. The cumulative rates of all-cause and cardiovascular death at 1-year follow-up were 24.1% and 15.6%, respectively. The 1-year all-cause mortality rate was significantly higher in the patients with post-procedural AR ≥ moderate compared with those with post-procedural AR ≤ mild (46.1% vs. 21.8%; log-rank p = 0.001). On multivariable analysis, post-procedural AR ≥ moderate was independently associated with 1-year all-cause mortality (hazard ratio: 2.85; 95% confidence interval: 1.52 to 5.35; p = 0.001). Compared with the early-generation devices, TAVR using the new-generation devices was associated with improved procedural outcomes in treating patients with pure native AR. In patients with pure native AR, significant post-procedural AR was independently associated with increased mortality. [Display omitted]
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2017.10.006
PMID: 29191323
Source: Geneva Foundation Free Medical Journals at publisher websites
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Transcatheter Aortic Valve Replacement in Pure Native Aortic Valve Regurgitation

2017 American College of Cardiology Foundation ;Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;Copyright Elsevier Limited Dec 5, 2017 ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2017.10.006 ;PMID: 29191323

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