Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Rogers, Toby; Thourani, Vinod H.; Waksman, Ron

doi:10.1161/jaha.117.007147

Cited by 22 publications

(11 citation statements)

References 60 publications

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“…BAV patients have not been eligible for randomized trials so far [ 34 – 37 ]. Other non-randomized, observational studies concerning the comparison of TAVI procedures in BAV and TAV patients yielded ambiguous results.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve

Chodór

Wilczek

Chodór-Rozwadowska

et al. 2021

pwki

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Introduction Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves. Aim To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing. Material and methods The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients. Results The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) ( p = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients ( p =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients ( p = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% ( p = NS) in group I and II respectively. Conclusions TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing.

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Section: Discussionmentioning

confidence: 99%

Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve

Chodór

Wilczek

Chodór-Rozwadowska

et al. 2021

pwki

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“…Moreover, the occurrence of non-positivity sometimes suggests a conceptual problem with the study design; the sampling scheme includes people for whom the treatment decision is less ambiguous (or even vividly clear) that it is nearly deterministic. This is the case, for instance, when some patients have specific counter-indication for one the drugs under study, when frail and old patients are considered not good candidates for some invasive open-heart surgery such as a surgical aortic valve replacement, 37 or when some younger, pre-menopausal women with uterine fibroids forgo hysterectomy and opt for myomectomy, a uterine-sparing treatment option, to keep alive their dream to bear children. 38 The evidence for making treatment decisions in such patients is apparently already strong, and thus the need for treatment effect estimation is less clear.…”

Section: Overview Of the Weighting Methodsmentioning

confidence: 99%

Propensity score weighting under limited overlap and model misspecification

Zhou

Matsouaka

Thomas

2020

Stat Methods Med Res

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Propensity score weighting methods are often used in non-randomized studies to adjust for confounding and assess treatment effects. The most popular among them, the inverse probability weighting, assigns weights that are proportional to the inverse of the conditional probability of a specific treatment assignment, given observed covariates. A key requirement for inverse probability weighting estimation is the positivity assumption, i.e. the propensity score must be bounded away from 0 and 1. In practice, violations of the positivity assumption often manifest by the presence of limited overlap in the propensity score distributions between treatment groups. When these practical violations occur, a small number of highly influential inverse probability weights may lead to unstable inverse probability weighting estimators, with biased estimates and large variances. To mitigate these issues, a number of alternative methods have been proposed, including inverse probability weighting trimming, overlap weights, matching weights, and entropy weights. Because overlap weights, matching weights, and entropy weights target the population for whom there is equipoise (and with adequate overlap) and their estimands depend on the true propensity score, a common criticism is that these estimators may be more sensitive to misspecifications of the propensity score model. In this paper, we conduct extensive simulation studies to compare the performances of inverse probability weighting and inverse probability weighting trimming against those of overlap weights, matching weights, and entropy weights under limited overlap and misspecified propensity score models. Across the wide range of scenarios we considered, overlap weights, matching weights, and entropy weights consistently outperform inverse probability weighting in terms of bias, root mean squared error, and coverage probability.

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“…However, improve-ments in the design of TAVI/TAVR and an increase in operator experience have improved procedure safety, leading to an expansion of indications for the procedure into low-risk groups without age restriction, such as in the PARTNER 3 trial[19][20][21][22][23]. As a result, the need to minimize radiation exposure during preprocedural TAVI/TAVR CT while ensuring diagnostic image quality is gaining importance.…”

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confidence: 99%

Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution’s Experience

Shnayien

Bressem

Beetz

et al. 2020

Rofo

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Purpose To retrospectively investigate the effectiveness of a novel 3-phase protocol for computed tomography (CT) before transcatheter aortic valve implantation/transcatheter aortic valve replacement (TAVI/TAVR) in terms of radiation dose and image quality. Materials and Methods A total of 107 nonrandomized patients (81 ± 7.4 years) scheduled for TAVI/TAVR underwent preprocedural CT on an 80-row CT scanner. 55 patients underwent a combined ECG-synchronized spiral scan of the chest and non-ECG-synchronized spiral scan of the abdomen/pelvis as recommended by the Society of Cardiovascular Computed Tomography (SCCT). 52 patients underwent an updated 3-phase variable helical pitch (vHP3) protocol combining a non-ECG-synchronized spiral scan of the upper thoracic aperture, followed by a prospective ECG-synchronized spiral scan of the heart, and a non-ECG-synchronized abdominal/pelvic spiral scan. The radiation dose was determined from an automatically generated protocol based on the CT dose index (CTDI). Objective image quality in terms of vessel attenuation and image noise was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. Subjective image quality was evaluated using a 4-point scale and compared for interrater agreement using Cohen’s weighted kappa coefficient (κw). All data were compared and statistically analyzed. Results Use of the novel 3-phase vHP3 protocol reduced the dose-length product (DLP) from 1256.58 ± 619.05 mGy*cm to 790.90 ± 238.15 mGy*cm, reducing the effective dose (E) from 21.36 ± 10.52 mSv to 13.44 ± 4.05 mSv and size-specific dose estimates (SSDE) from 20.85 ± 7.29 mGy to 13.84 ± 2.94 mGy (p < 0.001). There were no significant differences in objective and subjective image quality between the two protocols and between the two readers. Conclusion The novel 3-phase vHP3 protocol significantly reduces the radiation dose of preprocedural TAVI/TAVR CT without a loss of image quality. Key Points: Citation Format

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Transcatheter Aortic Valve Replacement in Intermediate‐ and Low‐Risk Patients

Cited by 22 publications

References 60 publications

Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve

Comparison of the results of transcatheter aortic valve implantation in patients with bicuspid and tricuspid aortic valve

Propensity score weighting under limited overlap and model misspecification

Radiation Dose Reduction in Preprocedural CT Imaging for TAVI/TAVR Using a Novel 3-Phase Protocol: A Single Institution’s Experience

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