Dvir, Danny and Webb, John G. and Bleiziffer, Sabine and Pasic, Miralem and Waksman, Ron and Kodali, Susheel and Barbanti, Marco and Latib, Azeem and Schaefer, Ulrich and Rodes-Cabau, Josep and Treede, Hendrik and Piazza, Nicolo and Hildick-Smith, David and Himbert, Dominique and Walther, Thomas and Hengstenberg, Christian and Nissen, Henrik and Bekeredjian, Raffi and Presbitero, Patrizia and Ferrari, Enrico and Segev, Amit and de Weger, Arend and Windecker, Stephan and Moat, Neil E. and Napodano, Massimo and Wilbring, Manuel and Cerillo, Alfredo G. and Brecker, Stephen and Tchetche, Didier and Lefevre, Thierry and De Marco, Federico and Fiorina, Claudia and Petronio, Anna Sonia and Teles, Rui C. and Testa, Luca and Laborde, Jean-Claude and Leon, Martin B. and Kornowski, Ran (2014) Transcatheter Aortic Valve Implantation in Failed Bioprosthetic Surgical Valves. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 312 (2). pp. 162-170. ISSN 0098-7484, 1538-3598
Full text not available from this repository. (Request a copy)Abstract
IMPORTANCE Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed. OBJECTIVE To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves. DESIGN, SETTING, AND PARTICIPANTS Correlates for survivalwere evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8%[interquartile range, 7.7%-16%]). Surgical valves were classified as small (<= 21 mm; 29.7%), intermediate (> 21 and < 25 mm; 39.3%), and large (<= 25 mm; 31%). Implanted devices included both balloon-and self-expandable valves. MAIN OUTCOMES AND MEASURES Survival, stroke, and New York Heart Association functional class. RESULTS Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P =.005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2%(95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P =.01). Similarly, patients with small valves had worse 1-year survival (74.8%[95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P =.001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (<= 21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P =.02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P =.008). CONCLUSIONS AND RELEVANCE In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | PROSTHESIS-PATIENT MISMATCH; HIGH-RISK PATIENTS; HEART-VALVES; NATIONAL DATABASE; ELDERLY-PATIENTS; REPLACEMENT; STENOSIS; IMPACT; ENLARGEMENT; SURVIVAL; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin II |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 16 Sep 2019 09:06 |
| Last Modified: | 16 Sep 2019 09:06 |
| URI: | https://pred.uni-regensburg.de/id/eprint/9893 |
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