Transcatheter Compared With Surgical Aortic Valve Replacement in Patients With Previous Chest-Directed Radiation Therapy.
CKD, chronic kidney disease
CRT-AS, chest-directed radiation therapy and aortic stenosis
EMR, electronic medical record
ICU, intensive care unit
IPT, inverse probability of treatment
LOS, length of stay
O/E, observed/expected
PPM, permanent pacemaker
PROM, predicted risk of operative mortality
SAVR, surgical aortic valve replacement
STS, Society for Thoracic Surgeons
TAVR, transcatheter aortic valve replacement
outcomes
thoracic oncology
valvular disease
Journal
JACC. CardioOncology
ISSN: 2666-0873
Titre abrégé: JACC CardioOncol
Pays: United States
ID NLM: 101761697
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
09
03
2020
revised:
20
07
2021
accepted:
20
07
2021
entrez:
4
10
2021
pubmed:
5
10
2021
medline:
5
10
2021
Statut:
epublish
Résumé
Cardiac surgery for radiation-induced valvular disease is associated with adverse outcomes. Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with a history of chest-directed radiation therapy and aortic stenosis (CRT-AS). We examined outcomes of TAVR compared with surgical aortic valve replacement (SAVR) for patients with CRT-AS. We identified 69 patients with CRT-AS who underwent TAVR from January 2012 to September 2018. Operative mortality, postoperative morbidities, and length of hospitalization were compared with 117 contemporaneous patients with CRT-AS who underwent isolated SAVR. Age-adjusted survival was evaluated by means of Cox proportional hazards modeling. Compared with SAVR patients, TAVR patients were older (mean age 75 ± 11.5 vs 65 ± 11.5 years), with more comorbidities, such as chronic obstructive pulmonary disease, atrial fibrillation, and peripheral vascular disease (all TAVR was associated with excellent in-hospital outcomes and better survival compared with intermediate-/high-risk SAVR in patients with CRT-AS. While SAVR still has a role in low-risk patients or those for whom TAVR is unsuitable for technical or anatomical reasons, TAVR is emerging as the standard of care for intermediate-/high-risk CRT-AS patients.
Sections du résumé
BACKGROUND
BACKGROUND
Cardiac surgery for radiation-induced valvular disease is associated with adverse outcomes. Transcatheter aortic valve replacement (TAVR) is increasingly used in patients with a history of chest-directed radiation therapy and aortic stenosis (CRT-AS).
OBJECTIVES
OBJECTIVE
We examined outcomes of TAVR compared with surgical aortic valve replacement (SAVR) for patients with CRT-AS.
METHODS
METHODS
We identified 69 patients with CRT-AS who underwent TAVR from January 2012 to September 2018. Operative mortality, postoperative morbidities, and length of hospitalization were compared with 117 contemporaneous patients with CRT-AS who underwent isolated SAVR. Age-adjusted survival was evaluated by means of Cox proportional hazards modeling.
RESULTS
RESULTS
Compared with SAVR patients, TAVR patients were older (mean age 75 ± 11.5 vs 65 ± 11.5 years), with more comorbidities, such as chronic obstructive pulmonary disease, atrial fibrillation, and peripheral vascular disease (all
CONCLUSIONS
CONCLUSIONS
TAVR was associated with excellent in-hospital outcomes and better survival compared with intermediate-/high-risk SAVR in patients with CRT-AS. While SAVR still has a role in low-risk patients or those for whom TAVR is unsuitable for technical or anatomical reasons, TAVR is emerging as the standard of care for intermediate-/high-risk CRT-AS patients.
Identifiants
pubmed: 34604800
doi: 10.1016/j.jaccao.2021.07.005
pii: S2666-0873(21)00159-9
pmc: PMC8463724
doi:
Types de publication
Journal Article
Langues
eng
Pagination
397-407Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
Dr Nohria is a consultant for Takeda and receives research support from Amgen. Dr Shah is a speaker and proctor for Edwards Lifesciences. Dr Kaneko is a speaker for Edwards Lifesciences and Medtronic and a consultant for Baylis Medical and 4C. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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