Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis

Deharo, Pierre; Bisson, Arnaud; Herbert, Julien; Lacour, Thibaud; Etienne, Christophe Saint; Jaussaud, Nicolas; Théron, Alexis; Collart, Frédéric; Bourguignon, Thierry; Cuisset, Thomas; Fauchier, Laurent

doi:10.1016/j.acvd.2020.04.005

Cited by 6 publications

(3 citation statements)

References 31 publications

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“…The HFRS has been widely adopted, but diagnostic information from past admissions is inconsistently used. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 At face value, using more information is always better, increasing the likelihood that the HFRS captures the true effect of frailty risk on patient outcomes. However, obtaining historical data might incur costs and, even if these costs were marginal, they might not be worth incurring if the extra data do not offer substantial additional information.…”

Section: Introductionmentioning

confidence: 99%

“…Second, studies will have internal inconsistency when constructing the HFRS if the look-back window had been defined by the period covered by the dataset but varied for individuals in the dataset. 20 , 21 Take a 2-year dataset, for instance: if a patient died at the start of these 2 years, they might only have a single record even though they might have been in hospital several times in the year or two before the start of the period covered by the data. For such an individual, their previous admissions would be unobserved and their frailty risk would be understated.…”

Section: Introductionmentioning

confidence: 99%

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The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Street

Maynou

Gilbert

et al. 2021

The Lancet Healthy Longevity

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Summary Background The Hospital Frailty Risk Score (HFRS) has been widely but inconsistently applied in published studies, particularly in how diagnostic information recorded in previous hospital admissions is used in its construction. We aimed to assess how many previous admissions should be considered when constructing the HFRS and the influence of frailty risk on long length of stay, in-hospital mortality, and 30-day readmission. Methods This is a retrospective observational cohort study of patients aged 75 years or older who had at least one emergency admission to any of 49 hospital sites in the Yorkshire and Humber region of England, UK. We constructed multiple versions of the HFRS for each patient, each form incorporating diagnostic data from progressively more previous admissions in its construction within a 1-year or 2-year window. We assessed the ability of each form of the HFRS to predict long length of stay (>10 days), in-hospital death, and 30-day readmission. Findings Between April 1, 2013, and March 31, 2017, 282 091 patients had 675 155 hospital admissions. Regression analyses assessing the different constructions of HFRS showed that the form constructed with diagnostic information recorded in the current and previous two admissions within the preceding 2 years performed best for predicting all three outcomes. Under this construction, 263 432 (39·0%) of 674 615 patient admissions were classified as having low frailty risk, for whom 33 333 (12·7%) had a long length of stay, 10 145 (3·9%) died in hospital, and 45 226 (17·2%) were readmitted within 30 days. By contrast with those patients with low frailty risk, for those with intermediate frailty risk, the probability was 2·5-times higher (95% CI 2·4 to 2·6) for long length of stay, 2·17-times higher (2·1 to 2·2) for in-hospital death, and 0·7% higher (0·5 to 1) for readmission. For patients with high frailty risk, the probability was 4·3-times higher (4·2 to 4·5) for long length of stay, 2·48-times higher (2·4 to 2·6) for in-hospital death, and −1% (−1·2 to −0·5) lower for readmission than those with low frailty risk. The intermediate and high frailty risk categories were more important predictors of long length of stay than any of the other rich set of control variables included in our analysis. These categories also proved to be important predictors of in-hospital mortality, with only the Charlson Comorbidity Index offering greater predictive power. Interpretation We recommend constructing the HFRS with diagnostic information from the current admission and from the previous two admissions in the preceding 2 years. This HFRS form was a powerful predictor of long length of stay and in-hospital mortality, but less so of emergency readmissions. Funding National Institute of Health Research.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Street

Maynou

Gilbert

et al. 2021

The Lancet Healthy Longevity

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“… 3 , 4 , 5 , 6 More recently, transcatheter aortic valve replacement (TAVR) in a degenerated surgical aortic valve (TAV‐in‐SAV) has emerged as a less invasive alternative to surgical reoperation for these patients. 6 , 7 , 8 …”

mentioning

confidence: 99%

Transcatheter Aortic Valve Replacement With Self‐Expandable Supra‐Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry

Dallan

Forrest

Reardon

et al. 2021

JAHA

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Background Transcatheter aortic valve replacement with supra‐annular transcatheter heart valves has been adopted in patients with degenerated surgical aortic valves. The next generation self‐expanding Evolut PRO valve has not been evaluated in patients with surgical valve failure. Methods and Results Patients undergoing transcatheter aortic valve replacement in degenerated surgical aortic valve procedures using the Evolut R or Evolut PRO transcatheter heart valves in the Society of Thoracic Surgeons and American College of Cardiology Transcatheter Valve Therapy Registry between April 2015 and June 2019 were evaluated. Transcatheter valve performance was evaluated by clinical site echocardiography. In‐hospital, 30‐day, and 1‐year clinical outcomes were based on the Society of Thoracic Surgeons‐American College of Cardiology‐Transcatheter Valve Therapy registry definitions. Transcatheter aortic valve replacement in degenerated surgical aortic valve was performed in 5897 patients (5061 [85.8%] patients received the Evolut R valve and 836 [14.2%] received the Evolut PRO valve). Thirty‐day transcatheter heart valves hemodynamic performance was excellent in both groups (mean gradient: Evolut PRO: 13.8±7.5 mm Hg; Evolut R: 14.5±8.1 mm Hg), while paravalvular regurgitation was significantly different between valve types ( P =0.02). Clinical events were low at 30 days (Evolut PRO: for the all‐cause mortality, 2.8%, any stroke was 1.8%, new pacemaker implantation, 3.0%: Evolut R:all‐cause mortality, 2.5%, any stroke was 2.2%, new pacemaker implantation, 5.3%) and 1 year (Evolut PRO: all‐cause mortality, 9.2%; any stroke, 3.1%; Evolut R: all‐cause mortality, 9.8%; any stroke, 2.9%). Conclusions Transcatheter aortic valve replacement in degenerated surgical aortic valve with self‐expandable supra‐annular transcatheter heart valves is associated with excellent clinical outcomes and valve hemodynamics. Additional reductions in residual paravalvular regurgitation were obtained with the next generation Evolut PRO.

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Structural valve degeneration: Redo or valve-in-valve? Enough meta-analysis and retrospective studies, we need a randomised trial

Lebreton

2021

Archives of Cardiovascular Diseases

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Valve-in-valve transcatheter aortic valve implantation after failed surgically implanted aortic bioprosthesis versus native transcatheter aortic valve implantation for aortic stenosis: Data from a nationwide analysis

Cited by 6 publications

References 31 publications

The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

The use of linked routine data to optimise calculation of the Hospital Frailty Risk Score on the basis of previous hospital admissions: a retrospective observational cohort study

Transcatheter Aortic Valve Replacement With Self‐Expandable Supra‐Annular Valves for Degenerated Surgical Bioprostheses: Insights From Transcatheter Valve Therapy Registry

Structural valve degeneration: Redo or valve-in-valve? Enough meta-analysis and retrospective studies, we need a randomised trial

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