Impact of Flow on Prosthesis-Patient Mismatch Following Transcatheter and Surgical Aortic Valve Replacement.
Aged
Aged, 80 and over
Aortic Valve
/ diagnostic imaging
Aortic Valve Stenosis
/ diagnostic imaging
Echocardiography, Doppler, Pulsed
Female
Heart Valve Prosthesis
Heart Valve Prosthesis Implantation
/ adverse effects
Hemodynamics
Humans
Male
Patient Readmission
Postoperative Complications
/ mortality
Randomized Controlled Trials as Topic
Registries
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
aortic stenosis
prosthesis patient mismatch
stroke volume
surgical aortic valve replacement
transcatheter aortic valve replacement
Journal
Circulation. Cardiovascular imaging
ISSN: 1942-0080
Titre abrégé: Circ Cardiovasc Imaging
Pays: United States
ID NLM: 101479935
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
pubmed:
14
8
2021
medline:
30
11
2021
entrez:
13
8
2021
Statut:
ppublish
Résumé
Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points. Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%, Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT02687035.
Sections du résumé
BACKGROUND
Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm
METHODS
We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points.
RESULTS
Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%,
CONCLUSIONS
Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT01314313 and NCT02687035.
Identifiants
pubmed: 34387097
doi: 10.1161/CIRCIMAGING.120.012364
doi:
Banques de données
ClinicalTrials.gov
['NCT01314313', 'NCT02687035']
Types de publication
Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e012364Commentaires et corrections
Type : CommentIn