A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry

Maeda, Koichi; Kumamaru, Hiraku; Kohsaka, Shun; Shimamura, Kazuo; Mizote, Isamu; Yamashita, Kizuku; Kawamura, Ai; Mukai, Takashi; Nakamura, Daisuke; Takeda, Yasuharu; Shimizu, Hideyuki; Sakata, Yasushi; Kuratani, Toru; Miyagawa, Shigeru; Sawa, Yoshiki

doi:10.1016/j.jacasi.2022.06.002

Cited by 8 publications

(5 citation statements)

References 32 publications

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“…Although it is desirable to include the prognostic factors reported in the J-TVT registry such as NYHA classification, chronic obstructive pulmonary disease and peripheral vascular disease, we believe that including the STS score will bring us closer to a solution. 22 Left ventricular global longitudinal strain by strain analysis as an advanced echocardiographic method has been reported as useful in predicting prognosis in various diseases, including AS, but was not investigated in this study. [23][24][25] It is known that careful assessment is needed in the interpretation of data, such as algorithm differences between vendors and interobserver errors, and that analysis using unified software by core laboratory analysis need to…”

Section: Study Limitationsmentioning

confidence: 97%

Feasibility of Transcatheter Aortic Valve Implantation in Patients With Very Severe Aortic Stenosis

et al. 2023

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Background: Very severe aortic stenosis (AS) has a poor prognosis even in asymptomatic patients, and asymptomatic very severe AS is a Class IIa indication for aortic valve replacement, although the safety and effectiveness of transcatheter aortic valve implantation (TAVI) for very severe AS is not well-established. Methods and Results: This study included 366 patients undergoing TAVI at a single center, with 85 and 281 patients in the very severe AS (peak velocity ≥5 m/s or mean pressure gradient (PG) ≥60 mmHg) and severe AS groups, respectively. Procedural and clinical outcomes at 1-year follow-up were compared between groups. The calcium scores were significantly higher in the very severe AS group (2,864.5 vs. 1,405.8 arbitrary units [AU] (P<0.001). Although the patient-prosthesis mismatch rate was higher in the very severe AS group (38.3% vs. 25.7%; P=0.029), there was no significant difference in the early safety and clinical efficacy between the groups (16.5% vs. 17.1% and 12.0% vs. 18.9%, respectively). Similarly, there was no significant difference in all-cause mortality at 1 year (4.8% vs. 9.8%). Conclusions: Despite a higher incidence of prosthesis–patient mismatch in those with very severe AS, the procedural and clinical outcomes were comparable to those in patients with severe AS. TAVI may be a reasonable treatment option for very severe AS.

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Section: Study Limitationsmentioning

confidence: 97%

Feasibility of Transcatheter Aortic Valve Implantation in Patients With Very Severe Aortic Stenosis

et al. 2023

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“…With this in mind, in this issue of JACC: Asia , Maeda et al 4 used predictive modeling to estimate 1-year mortality after TAVR from a nationwide registry in Japan, the J-TVT (Japan-Transcatheter Valve Therapies) registry. Patients of intermediate to high operative risk (mean Society of Thoracic Surgeons Predicted Risk of Mortality score of 7.3% ± 4.8 %) who underwent TAVR between 2013 and 2018 were randomly assigned to a derivation cohort (n = 12,316) and a validation cohort (n = 5,339) in a 7:3 ratio.…”

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confidence: 99%

“…Because postoperative quality of life assessment was not included in the J-TVT registry, the authors could not study this outcome in their model. 3 Third, the model developed by Maeda et al 4 did not include physical or cognitive components of frailty. These markers were shown to be strong predictors of mortality following TAVR.…”

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confidence: 99%

“… 6 Finally, the simpler the model, the higher its chances of being widely accepted in practice. The 27 variables studied by Maeda et al 4 , despite being readily available, might represent a barrier to a wider use of their model.…”

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confidence: 99%

“…The prediction model presented by Maeda et al 4 confronts an unmet need: reliably predicting futility in TAVR recipients. One of the most difficult tasks in medicine is knowing when not to offer a treatment that won’t help, to honor the principle of first “doing no harm.” Effectively communicating this thought to patients and their families might be even more challenging.…”

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confidence: 99%

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Predicting Futility in Transcatheter Aortic Valve Replacement

Dagher

Ali²,

Modine³

2022

JACC: Asia

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Transcatheter Aortic Valve Implantation in Small and Very Small Aortic Valve Annuli: A Propensity‐Matched Analysis Between Self‐Expanding Versus Balloon‐Expandable Valves

Itach,

Loewenstein,

Zahler

et al. 2024

Cathet Cardio Intervent

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BackgroundThe management of Transcatheter Aortic Valve Implantation (TAVI) patients with a small aortic annulus (SAA) postures a substantial challenge, increasing the risk of patient‐ prosthesis mismatch (PPM) and overall mortality.AimsThis study aimed to compare the hemodynamic and clinical outcomes of transcatheter balloon‐expandable valve (BEV) versus transcatheter self‐expandable valve (SEV) in SAA.MethodsWe conducted propensity score matching (PSM) of severe AS patients with SAA who underwent trans‐femoral TAVR and enrolled to the Israeli TAVR registry between the years 2008 and 2023. SAA was defined as an aortic‐valve annulus area ≤ 430 mm2. Since the BEV used have a smaller size cut‐off, an additional analysis on very small aortic annulus (vSAA) as defined as aortic‐valve annulus area ≤ 345 mm2 was performed.ResultsThe study included 1364 consecutive patients with SAA of (BEV n = 485; SEV n = 879) at a mean age of 82 ± 7 years, of whom the vast majority were female (83%). Propensity‐matched groups comprised of 329 and 122 paired for the SAA and vSAA patients, respectively. As compared to BEV in the SAA and vSAA analyses, SEV showed lower rates of postprocedural of LBBB (32% vs. 22% and 41% vs. 22%; both p < 0.01, respectively), however, higher rates of major vascular complications (2% vs. 7% and 2% vs. 12%; both p < 0.01, respectively) and major or life‐threatening bleeding but only in vSAA group (17% vs. 9.1%, p = 0.009). One‐month mortality was higher in the SEV versus BEV in both SAA and vSAA comparisons (2% vs. 0.6%, p = 0.048 and 3% vs. 0%, p = 0.018; respectively). A nonsignificant trend of higher 5‐year mortality was observed in univariate models, noted mainly in vSAA patients (22% vs. 19%, p = 0.385; 24% vs. 15%, p = 0.073).ConclusionsThe present analysis observed higher rates of major vascular complications and 1‐month mortality in SAA and vSAA treated with SEV. A similar nonsignificant trend toward long‐term mortality for the vSAA group was observed and should be evaluated in larger cohorts.

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A Risk Model for 1-Year Mortality After Transcatheter Aortic Valve Replacement From the J-TVT Registry

Cited by 8 publications

References 32 publications

Feasibility of Transcatheter Aortic Valve Implantation in Patients With Very Severe Aortic Stenosis

Feasibility of Transcatheter Aortic Valve Implantation in Patients With Very Severe Aortic Stenosis

Predicting Futility in Transcatheter Aortic Valve Replacement

Transcatheter Aortic Valve Implantation in Small and Very Small Aortic Valve Annuli: A Propensity‐Matched Analysis Between Self‐Expanding Versus Balloon‐Expandable Valves

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