TY - JOUR
T1 - Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve
AU - Bleiziffer, Sabine
AU - Erlebach, Magdalena
AU - Simonato, Matheus
AU - Pibarot, Philippe
AU - Webb, John
AU - Capek, Lukas
AU - Windecker, Stephan
AU - George, Isaac
AU - Sinning, Jan Malte
AU - Horlick, Eric
AU - Napodano, Massimo
AU - Holzhey, David M.
AU - Petursson, Petur
AU - Cerillo, Alfredo
AU - Bonaros, Nikolaos
AU - Ferrari, Enrico
AU - Cohen, Mauricio G.
AU - Baquero, Giselle
AU - Jones, Tara L.
AU - Kalra, Ankur
AU - Reardon, Michael J.
AU - Chhatriwalla, Adnan
AU - Gama Ribeiro, Vasco
AU - Alnasser, Sami
AU - Van Mieghem, Nicolas M.
AU - Rustenbach, Christian Jörg
AU - Schofer, Joachim
AU - Garcia, Santiago
AU - Zeus, Tobias
AU - Champagnac, DIdier
AU - Bekeredjian, Raffi
AU - Kornowski, Ran
AU - Lange, Rüdiger
AU - Dvir, Danny
N1 - Publisher Copyright:
© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
PY - 2018/5/1
Y1 - 2018/5/1
N2 - Objective We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. Methods A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). Results Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). Conclusions Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.
AB - Objective We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. Methods A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as ≥20 mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). Results Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). Conclusions Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.
KW - prosthetic heart valves
KW - transcatheter valve interventions
KW - valve disease surgery
KW - valvular heart disease
UR - http://www.scopus.com/inward/record.url?scp=85046453775&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2017-312422
DO - 10.1136/heartjnl-2017-312422
M3 - Article
C2 - 29352008
AN - SCOPUS:85046453775
SN - 1355-6037
VL - 104
SP - 828
EP - 834
JO - Heart
JF - Heart
IS - 10
ER -