Transcatheter and surgical aortic valve replacement in patients with left ventricular dysfunction.
Aortic stenosis, AS
Heart failure
Left ventricular dysfunction
Left ventricular ejection fraction
Surgical aortic valve replacement, SAVR
Transcatheter aortic valve replacement, TAVR
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
18 Dec 2022
18 Dec 2022
Historique:
received:
23
02
2022
accepted:
06
12
2022
entrez:
18
12
2022
pubmed:
19
12
2022
medline:
21
12
2022
Statut:
epublish
Résumé
Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis. The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction. Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067-1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929-1.080, p = 0.964), respectively. Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.
Sections du résumé
BACKGROUND
BACKGROUND
Patients with severe aortic stenosis and left ventricular systolic dysfunction have a poor prognosis, and this may result in inferior survival also after aortic valve replacement. The outcomes of transcatheter and surgical aortic valve replacement were investigated in this comparative analysis.
METHODS
METHODS
The retrospective nationwide FinnValve registry included data on patients who underwent transcatheter or surgical aortic valve replacement with a bioprosthesis for severe aortic stenosis. Propensity score matching was performed to adjust the outcomes for baseline covariates of patients with reduced (≤ 50%) left ventricular ejection fraction.
RESULTS
RESULTS
Within the unselected, consecutive 6463 patients included in the registry, the prevalence of reduced ejection fraction was 20.8% (876 patients) in the surgical cohort and 27.7% (452 patients) in the transcatheter cohort. Reduced left ventricular ejection fraction was associated with decreased survival (adjusted hazards ratio 1.215, 95%CI 1.067-1.385) after a mean follow-up of 3.6 years. Among 255 propensity score matched pairs, 30-day mortality was 3.1% after transcatheter and 7.8% after surgical intervention (p = 0.038). One-year and 4-year survival were 87.5% and 65.9% after transcatheter intervention and 83.9% and 69.6% after surgical intervention (restricted mean survival time ratio, 1.002, 95%CI 0.929-1.080, p = 0.964), respectively.
CONCLUSIONS
CONCLUSIONS
Reduced left ventricular ejection fraction was associated with increased morbidity and mortality after surgical and transcatheter aortic valve replacement. Thirty-day mortality was higher after surgery, but intermediate-term survival was comparable to transcatheter intervention. Trial registration The FinnValve registry ClinicalTrials.gov Identifier: NCT03385915.
Identifiants
pubmed: 36529781
doi: 10.1186/s13019-022-02061-9
pii: 10.1186/s13019-022-02061-9
pmc: PMC9759878
doi:
Banques de données
ClinicalTrials.gov
['NCT03385915']
Types de publication
Clinical Trial
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
322Informations de copyright
© 2022. The Author(s).
Références
Front Cardiovasc Med. 2018 Aug 17;5:111
pubmed: 30175103
Eur Heart J. 2017 Sep 21;38(36):2739-2791
pubmed: 28886619
Eur J Heart Fail. 2016 May;18(5):469-81
pubmed: 26725980
N Engl J Med. 2020 Jan 9;382(2):111-119
pubmed: 31733181
Ann Thorac Surg. 2020 Jan;109(1):110-117
pubmed: 31288017
Circ Heart Fail. 2017 Jan;10(1):
pubmed: 28087687
Circulation. 2013 Jun 11;127(23):2316-26
pubmed: 23661722
JAMA Cardiol. 2018 Nov 1;3(11):1060-1068
pubmed: 30285058
J Am Coll Cardiol. 2016 May 24;67(20):2349-2358
pubmed: 27199058
Ann Transl Med. 2014 Jan;2(1):10
pubmed: 25332986
Heart Fail Rev. 2018 Nov;23(6):821-829
pubmed: 30094532
Lancet. 1999 Jan 16;353(9148):205-6
pubmed: 9923878
Eur J Cardiothorac Surg. 2012 Apr;41(4):734-44; discussion 744-5
pubmed: 22378855
J Thorac Cardiovasc Surg. 2019 Oct;158(4):984-991.e1
pubmed: 30578054
Circ Cardiovasc Imaging. 2015 Apr;8(4):
pubmed: 25852129
JACC Cardiovasc Imaging. 2019 Jan;12(1):163-171
pubmed: 30621988
Eur J Cardiothorac Surg. 2012 Nov;42(5):S45-60
pubmed: 23026738
J Am Coll Cardiol. 2012 Dec 4;60(22):2325-9
pubmed: 23122793
Circulation. 2021 Feb 2;143(5):e72-e227
pubmed: 33332150
J Cardiothorac Surg. 2015 Jun 30;10:90
pubmed: 26123033
Ann Med. 2019 May - Jun;51(3-4):270-279
pubmed: 31112060
JACC Cardiovasc Interv. 2018 Jan 22;11(2):145-157
pubmed: 29289632
J Am Coll Cardiol. 2018 Mar 27;71(12):1313-1321
pubmed: 29566814
J Intern Med. 1997 May;241(5):387-94
pubmed: 9183306
N Engl J Med. 2017 Apr 6;376(14):1321-1331
pubmed: 28304219
Circ Cardiovasc Interv. 2013 Dec;6(6):604-14
pubmed: 24221391
J Thorac Cardiovasc Surg. 2015 Feb;149(2):451-60
pubmed: 25308117
J Thorac Cardiovasc Surg. 2022 Aug 18;:
pubmed: 36150940
Circulation. 2015 Aug 25;132(8):741-7
pubmed: 26304665
Heart. 2007 Sep;93(9):1137-46
pubmed: 17699180
J Am Coll Cardiol. 2017 Dec 19;70(24):3026-3041
pubmed: 29241492
Heart. 2015 Mar;101(6):463-71
pubmed: 25586156
Eur Heart J. 2014 Jun 21;35(24):1599-607
pubmed: 24179072
Eur Heart J. 2017 Dec 01;38(45):3351-3358
pubmed: 29020232
N Engl J Med. 2011 Jun 9;364(23):2187-98
pubmed: 21639811