Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation

Okuno, Taishi; Tomii, Daijiro; Heg, Dik; Lanz, Jonas; Praz, Fabien; Stortecky, Stefan; Reineke, David; Windecker, Stephan; Pilgrim, Thomas

doi:10.4244/eij-d-21-00784

Cited by 56 publications

(30 citation statements)

References 32 publications

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“…This aspect might be one of the explanations for the worse survival in the TAVI group also observed in this meta‐analysis. Recently, Okuno et al 45 investigated the impact of mild PVL after TAVI on midterm outcomes. At 5 years, patients with mild PVL had a higher risk of death than those with none/trace PVL (54.6% vs. 43.8%; HR: 1.26; 95% CI: 1.06–1.50).…”

Section: Discussionmentioning

confidence: 99%

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Early and late outcomes of surgical aortic valve replacement with sutureless and rapid‐deployment valves versus transcatheter aortic valve implantation: Meta‐analysis with reconstructed time‐to‐event data of matched studies

Sá

Jabagi²,

Dokollari

et al. 2022

Cathet Cardio Intervent

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Sutureless/rapid-deployment (SURD) valves are options different from the stented prostheses included in the pivotal trials comparing surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI). We performed a metaanalysis with reconstructed time-to-event data of matched studies published by November 2021 to compare SURD-AVR and TAVI. Primary endpoints were 30-day mortality and overall survival in the follow-up. Secondary endpoints included: 30-day stroke, acute kidney injury (AKI), major bleeding, permanent pacemaker implantation (PPI), paravalvular leak (PVL), prosthesis-patient mismatch (PPM), postoperative aortic valve area (AVA), and mean gradients. Ten studies met our eligibility criteria, including a total of 5134 patients (2567 underwent SURD-AVR and 2567 underwent TAVI). Pooled risk of 30-day mortality did not favor any group (odds ratio [OR]: 0.69; 95% confidence interval [CI]: 0.31-1.53; p = 0.360). Patients undergoing SURD-AVR had lower risk of PVL (OR: 0.09; 95% CI: 0.05-0.17; p < 0.001). No statistically significant differences were observed for 30-day stroke, AKI, major bleeding, PPI, PPM, and postoperative AVA. In the follow-up, we observed a higher risk of mortality (hazard ratio: 1.74; 95% CI: 1.26-2.40; p < 0.001) with TAVI. Patients who underwent SURD-AVR experienced better survival, however, the interpretation of these results warrant caution due to the fact that SURD-AVR patients tended to be younger than TAVI patients. Structural heart surgeons and interventional cardiologists should consider initial risk and life expectancy when referring patients for one approach over the other.

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Section: Discussionmentioning

confidence: 99%

“…This aspect might be one of the explanations for the worse survival in the TAVI group also observed in this meta-analysis. Recently, Okuno et al 45…”

Section: Commentsmentioning

confidence: 99%

Early and late outcomes of surgical aortic valve replacement with sutureless and rapid‐deployment valves versus transcatheter aortic valve implantation: Meta‐analysis with reconstructed time‐to‐event data of matched studies

Sá

Jabagi²,

Dokollari

et al. 2022

Cathet Cardio Intervent

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“… 19 Moderate or severe PVR, although infrequent, is an important limitation of TAVI that has been shown to be associated with increased risk of mortality and bleeding. 30 , 31 Data on the association of aortic regurgitation with outcomes for noncardiac surgery are scarce; however, a single retrospective study 32 among 167 patients with chronic moderate or severe aortic regurgitation found that chronic aortic regurgitation was associated with increased risk of cardiopulmonary complications (16.2% vs 5.4%; P = .003) and higher in-hospital mortality (9.0% vs 1.8%; P = .008). These results suggest that it is crucial to achieve optimal hemodynamic outcome when performing prophylactic TAVI before elective noncardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation

et al. 2022

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“…Several registries illustrated that mild paravalvular leaks (more frequent in TAVI) may already be prognostically relevant. 39 40 The need for pacemaker implantations may be up to five times higher with TAVI 41 and may 42 or may not 43 be associated with decreased prognosis. In addition, TAVI is associated with a three to fourfold higher rate of cusp thrombosis, 34 which is associated with an increased risk of stroke during follow-up.…”

Section: Surgical Treatment Of Valve Diseasementioning

confidence: 99%

Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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Five-year outcomes of mild paravalvular regurgitation after transcatheter aortic valve implantation

Cited by 56 publications

References 32 publications

Early and late outcomes of surgical aortic valve replacement with sutureless and rapid‐deployment valves versus transcatheter aortic valve implantation: Meta‐analysis with reconstructed time‐to‐event data of matched studies

Early and late outcomes of surgical aortic valve replacement with sutureless and rapid‐deployment valves versus transcatheter aortic valve implantation: Meta‐analysis with reconstructed time‐to‐event data of matched studies

Risk and Timing of Noncardiac Surgery After Transcatheter Aortic Valve Implantation

Cardiac Surgery 2021 Reviewed

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