Transcatheter Aortic Valve Replacement in Patients With Symptomatic Severe Aortic Stenosis and Prior External Chest Radiation.
Aged
Aged, 80 and over
Aortic Valve
/ diagnostic imaging
Aortic Valve Stenosis
/ diagnostic imaging
Cancer Survivors
District of Columbia
/ epidemiology
Female
Heart Block
/ epidemiology
Hemodynamics
Humans
Length of Stay
Male
Middle Aged
Prevalence
Prospective Studies
Radiotherapy
Risk Factors
Severity of Illness Index
Thorax
/ radiation effects
Time Factors
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
Conduction abnormalities
Mortality
Prior chest radiation
Symptomatic severe aortic stenosis
Journal
Cardiovascular revascularization medicine : including molecular interventions
ISSN: 1878-0938
Titre abrégé: Cardiovasc Revasc Med
Pays: United States
ID NLM: 101238551
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
11
02
2019
accepted:
11
02
2019
entrez:
14
5
2019
pubmed:
14
5
2019
medline:
19
5
2020
Statut:
ppublish
Résumé
Surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (AS) and prior chest radiation is associated with poor outcomes in comparison with patients without prior radiation. Our objective was to compare clinical outcomes of patients with and without prior chest radiation undergoing transcatheter aortic valve replacement (TAVR) for symptomatic severe AS. Between January 2003 and January 2017, 1150 patients underwent TAVR at our institution. Of these, 44 had prior chest radiation. Baseline demographic and clinical characteristics, procedural details, and clinical outcomes were prospectively collected. Patients with prior chest radiation were younger, 76 ± 13 years, compared with those without prior chest radiation, 82 ± 8 years (p = 0.002). Median Society of Thoracic Surgeons score for chest radiation patients was 7 ± 4, compared to 8 ± 5 in those without prior radiation. Despite higher prevalence of complete heart block, there was no significant difference between the 2 groups with regard to the need for permanent pacemaker implantation. There was a trend toward longer length of intensive care unit stay in chest radiation patients, but there was no significant difference in 30-day or 1-year mortality. Thus, TAVR appears to be a safe treatment option in the short and medium term for patients with symptomatic severe AS and prior chest radiation.
Sections du résumé
BACKGROUND/PURPOSE
Surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (AS) and prior chest radiation is associated with poor outcomes in comparison with patients without prior radiation. Our objective was to compare clinical outcomes of patients with and without prior chest radiation undergoing transcatheter aortic valve replacement (TAVR) for symptomatic severe AS.
METHODS/MATERIALS
Between January 2003 and January 2017, 1150 patients underwent TAVR at our institution. Of these, 44 had prior chest radiation. Baseline demographic and clinical characteristics, procedural details, and clinical outcomes were prospectively collected.
RESULTS
Patients with prior chest radiation were younger, 76 ± 13 years, compared with those without prior chest radiation, 82 ± 8 years (p = 0.002). Median Society of Thoracic Surgeons score for chest radiation patients was 7 ± 4, compared to 8 ± 5 in those without prior radiation. Despite higher prevalence of complete heart block, there was no significant difference between the 2 groups with regard to the need for permanent pacemaker implantation. There was a trend toward longer length of intensive care unit stay in chest radiation patients, but there was no significant difference in 30-day or 1-year mortality.
CONCLUSIONS
Thus, TAVR appears to be a safe treatment option in the short and medium term for patients with symptomatic severe AS and prior chest radiation.
Identifiants
pubmed: 31079816
pii: S1553-8389(19)30148-4
doi: 10.1016/j.carrev.2019.02.015
pii:
doi:
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
376-380Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019. Published by Elsevier Inc.