Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis—predictors of mortality and poor treatment response

Gotzmann, Michael; Pljakic, Azem; Bojara, Waldemar; Lindstaedt, Michael; Ewers, Aydan; Germing, Alfried; Mügge, Andreas

doi:10.1016/j.ahj.2011.05.011

Cited by 101 publications

(65 citation statements)

References 25 publications

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“…Gotzmann P values for log-rank test (categorical variables) or Wald test (continuous variables) as regards 30-day to 1-year overall mortality. by guest on May 11, 2018 http://circinterventions.ahajournals.org/ Downloaded from et al 13 also reported PH to be significantly related to all-cause mortality after TAVI, as was reduced LVEF (as in the present study), with severe systolic LV impairment (LVEF <30%) further identified as an independent predictor of mortality at 1 year. In the present study, cardiovascular event-free survival at 1 year was 72% in group I, 67% in group II (P=0.2), and 67% in group III (P=0.1); likewise, stroke occurred in 2.7%, 2%, and 2.5% and myocardial infarction in 1.4%, 1.3%, and 1.05% of cases, respectively (ie, with no significant difference).…”

Section: Discussionsupporting

confidence: 57%

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Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Luçon

Oger

Bédossa

et al. 2014

Circ: Cardiovascular Interventions

108

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Background-Pulmonary hypertension (PH) is associated with poor prognosis in patients with severe aortic stenosis. The aim of this multicenter study was to describe clinical outcome after transcatheter aortic valve implantation. Methods and Results-The FRANCE 2 Registry included all patients undergoing transcatheter aortic valve implantation in France in 2010 and 2011. Patients were divided into 3 groups depending on systolic pulmonary artery pressure (sPAP) estimated in transthoracic echocardiography: group I, sPAP <40 mm Hg (no PH); group II, sPAP 40 to 59 mm Hg (mildto-moderate PH); and group III, sPAP ≥60 mm Hg (severe PH). Patients were followed up for 1 year. A total of 2435 patients whose pre-transcatheter aortic valve implantation sPAP was reported were included. A total of 845 were in group I (34.7%), 1112 in group II (45.7%), and 478 in group III (19.6%). Procedural success, early complications, and 30-day mortality were statistically similar across sPAP groups. One-year mortality was higher in groups II and III (group I, 22%; group II, 28%; and group III, 28%; P=0.032). Mild-to-moderate and severe PH were identified as an independent factor of all-cause mortality. The major adverse cardiovascular event rates did not differ according to sPAP. New York Health Association functional class improved significantly in all groups. Conclusions-PH (sPAP ≥40 mm Hg) in patients with aortic stenosis undergoing transcatheter aortic valve implantation was associated with increased 1-year mortality especially when severe (sPAP ≥60 mm Hg) but not with increased 30-day mortality, and functional status was significantly improved regardless of PAP level. (Circ Cardiovasc Interv. 2014;7:240-247.)

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Section: Discussionsupporting

confidence: 57%

“…Previous studies showed that severe PH increased mortality in TAVI as in surgical AVR. 3,[11][12][13] In 2010, a prospective national TAVI registry was initiated in France. The FRANCE 2 Registry reflects real-life experience, including consecutive patients from all centers in France.…”

mentioning

confidence: 99%

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Luçon

Oger

Bédossa

et al. 2014

Circ: Cardiovascular Interventions

108

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“…While several authors have reported mitral regurgitation to be an independent predictor of mortality, 34,35 other studies have not supported this observation. 36,103 Although post-procedural mortality seems to be higher in patients with concomitant mitral valve regurgitation, functional status is generally improved.…”

Section: Concomitant Mitral Valve Regurgitationmentioning

confidence: 53%

“…17,19,21 Additional risk factors are left-ventricular dysfunction, coronary artery disease, diabetes, prior balloon valvuloplasty, prior acute pulmonary edema, and tricuspid regurgitation, whereas the impact of mitral regurgitation is still unclear. 10,[34][35][36] Apart from clinical factors, there are a number of anatomical contraindications for TAVR that have been summarized in the ESC/EACTS guidelines that will be discussed in detail further on in this article. They include an annulus size smaller than 18 mm or larger than 29 mm, endocarditis or left-ventricular thrombus, high risk of coronary ostium obstruction, plaques with thrombi in the aortic arch, and inadequate vascular or transapical access.…”

Section: Patient Selection For Tavrmentioning

confidence: 99%

Transcatheter aortic valve replacement

Damberg¹,

Benstoem²,

Autschbach³

et al. 2013

RRCC

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Abstract:The standard treatment for symptomatic severe aortic valve stenosis is surgical aortic valve replacement. Over the last decade, transcatheter aortic valve replacement has emerged as an option for patients judged inoperable. It might also constitute an alternative for high-risk patients, even though which patients might benefit from this approach is still being discussed and remains controversial. Transcatheter heart valve replacement is a rapidly spreading technology. However, a number of problems still need to be addressed, such as paravalvular regurgitation, stroke rate, and postoperative conduction disturbances. Further, the durability of transcatheter heart valves remains unclear. Randomized clinical trials and long-term follow-up will help define the role of transcatheter heart valve replacement in aortic stenosis therapy.

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“…the impact of concomitant Mr on the improvement of symptoms and quality of life after aVr isalso a point of great interest.a 2011 study 24 showed that severe Mr was an independent predictor of poor treatment response to taVr, with treatment response defined as improvement of at least one Nyha class 6 months after taVr. In a study by ruel et al 6 significant MR was associated with a higher incidence of heart failure symptoms in patients which had undergone aVr for as, but only when it was associated with at least one risk factor (left atrial diameter >5 cm, peak aortic gradient >60 mm hg, mean aortic gradient >40 mm Hg and atrial fibrillation).…”

Section: Significant Mr and Functional Status In Patients Undergoing Avrmentioning

confidence: 99%

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

Iudice¹,

Galderisi²

2015

ICFJ

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Significant mitral regurgitation (MR) - either of structural or functional origin - is a frequent condition in patients with severe aortic stenosis (AS), candidate to aortic valve replacement (AVR), and raises the problem whether or not to intervene on mitral valve at the same time. Surgical risk related to the double valve intervention is still significantly higher compared to isolated AVR and international guidelines do not always give definite indications in the presence of multiple valve disease. Furthermore, the increasing diffusion of transcatheter aortic valve replacement for patients at high surgical risk has risen the problem of leaving the concomitant MR untreated. This review is an attempt to give a practical guide for the decision-making process about the treatment strategy of patients with concomitant severe AS and significant MR, analyzing the impact of a persistent MR on prognosis after surgical or transcatheter AVR, the main predictors of MR improvement after isolated AVR - according to the current literature – and displaying the emerging approach involving transcatheter treatment of both AS and MR.

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Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis—predictors of mortality and poor treatment response

Cited by 101 publications

References 25 publications

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Prognostic Implications of Pulmonary Hypertension in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Implantation

Transcatheter aortic valve replacement

Concomitant significant mitral regurgitation in patients with aortic valve stenosis undergoing valve replacement: Practical indications

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