Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement.

Adolescent Adult Aged Aged, 80 and over Child Child, Preschool Endocarditis / epidemiology Endovascular Procedures / adverse effects Heart Valve Prosthesis Implantation / adverse effects Humans Infant Middle Aged Postoperative Complications / epidemiology Reoperation / adverse effects Retrospective Studies Thrombosis / epidemiology Treatment Outcome Tricuspid Valve / surgery Young Adult

endocarditis percutaneous valve stenosis thrombus transcatheter valve implantation

Journal

Journal of the American College of Cardiology

ISSN: 1558-3597

Titre abrégé: J Am Coll Cardiol

Pays: United States

ID NLM: 8301365

Informations de publication

Date de publication:
22 01 2019

Historique:

received: 27 05 2018

revised: 30 09 2018

accepted: 08 10 2018

entrez: 19 1 2019

pubmed: 19 1 2019

medline: 19 11 2019

Statut: ppublish

Résumé

Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

Sections du résumé

BACKGROUND

OBJECTIVES

The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes.

METHODS

Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed.

RESULTS

Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type.

CONCLUSIONS

TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR.

Identifiants

DOI: 10.1016/j.jacc.2018.10.051 PMID: 30654886

pubmed: 30654886

pii: S0735-1097(18)39088-0

doi: 10.1016/j.jacc.2018.10.051

pii:

doi:

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

148-157

Investigateurs

Younes Boudjemline (Y)

Guiti Milani (G)

Martin L Bocks (ML)

Jeremy D Asnes (JD)

Vaikom Mahadevan (V)

Dominique Himbert (D)

Bryan H Goldstein (BH)

Thomas E Fagan (TE)

John P Cheatham (JP)

Tarek S Momenah (TS)

Dennis W Kim (DW)

Antonio Colombo (A)

Marco Ancona (M)

Gianfranco Butera (G)

Thomas J Forbes (TJ)

Eric Horlick (E)

Carlos Pedra (C)

Jacopo Alfonsi (J)

Thomas K Jones (TK)

Susan Foerster (S)

Shabana Shahanavaz (S)

Ivory Crittendon (I)

Dietmar Schranz (D)

Athar Qureshi (A)

Martyn Thomas (M)

Damien P Kenny (DP)

Mark Hoyer (M)

Sabine Bleiziffer (S)

Joelle Kefer (J)

Luca Testa (L)

Matthew Gillespie (M)

Danyal Khan (D)

Robert H Pass (RH)

Mohamed Abdel-Wahab (M)

Harindra Wijeysundera (H)

Filip Casselman (F)

Tabitha Moe (T)

Nicholas Hayes (N)

Oluseun Alli (O)

Keshav R Nayak (KR)

Priti Patel (P)

Nicolo Piazza (N)

Cameron Seaman (C)

Stephan Windecker (S)

James Kuo (J)

Frank F Ing (FF)

Raj R Makkar (RR)

Martin Greif (M)

Alfredo G Cerillio (AG)

Didier Champagnac (D)

Fabian Nietlispach (F)

Francesco Maisano (F)

Hendrik Treede (H)

Moritz Seiffert (M)

Rui Campante Teles (RC)

Gudrun Feuchtner (G)

Nikolaos Bonaros (N)

Giuseppe Bruschi (G)

Gabriele Pesarini (G)

Commentaires et corrections

Type : CommentIn