Outcomes in Valve-in-Valve Transcatheter Aortic Valve Implantation
Por:
van Nieuwkerk, AC, Santos, RB, Fernandez-Nofrerias, E, Tchetche, D, de Brito, FS, Barbanti, M, Kornowski, R, Latib, A, D'Onofrio, A, Ribichini, F, Mainar, V, Dumonteil, N, Baan, J, Abizaid, A, Sartori, S, D'Errigo, P, Tarantini, G, Lunardi, M, Orvin, K, Pagnesi, M, Larraya, GL, Ghattas, A, Dangas, G, Mehran, R and Delewi, R
Publicada:
1 jun 2022
Ahead of Print:
1 may 2022
Resumen:
The use of valve-in-valve transcatheter aortic valve implantation (ViV-TAVI) is increasing, but studies evaluating clinical outcomes in these patients are scarce. Also, there are limited data to guide the choice of valve type in ViV-TAVI. Therefore, this CENTER-study evaluated clinical outcomes in patients with ViV-TAVI compared to patients with native valve TAVI (NV-TAVI). In addition, we compared outcomes in patients with ViV-TAVI treated with self-expandable versus balloon-expandable valves. A total of 256 patients with ViV-TAVI and 11333 patients with NV-TAVI were matched 1:2 using propensity score matching, resulting in 256 patients with ViV-TAVI and 512 patients with NV-TAVI. Mean age was 81 +/- 7 years, 58% were female, and the Society of Thoracic Surgeons Predicted Risk of Mortality was 6.3% (4.0% to 12.8%). Mortality rates were comparable between ViV-TAVI and NV-TAVI patients at 30 days (4.1% vs 5.9%, p = 0.30) and 1 year (14.2% vs 17.3%, p = 0.34). Stroke rates were also similar at 30 days (2.8% vs 1.8%, p = 0.38) and 1 year (4.9% vs 4.3%, p = 0.74). Permanent pacemakers were less frequently implanted in patients with ViV-TAVI (8.8% vs 15.0%, relative risk 0.59, 95% confidence interval [CI] 0.37 to 0.92, p = 0.02). Patients with ViV-TAVI were treated with self-expandable valves (n = 162) and balloon-expandable valves (n = 94). Thirty-day major bleeding was less frequent in patients with self-expandable valves (3% vs 13%, odds ratio 5.12, 95% CI 1.42 to 18.52, p = 0.01). Thirty-day mortality was numerically lower in patients with self-expandable valves (3% vs 7%, odds ratio 3.35, 95% CI 0.77 to 14.51, p = 0.11). In conclusion, ViV-TAVI seems a safe and effective treatment for failing bioprosthetic valves with low mortality and stroke rates comparable to NV-TAVI for both valve types. (C) 2022 The Author(s). Published by Elsevier Inc.
Filiaciones:
van Nieuwkerk, AC:
Univ Amsterdam, Amsterdam Univ, Heart Ctr, Dept Clin & Expt Cardiol,Med Ctr, Amsterdam, Netherlands
Santos, RB:
Univ Amsterdam, Amsterdam Univ, Heart Ctr, Dept Clin & Expt Cardiol,Med Ctr, Amsterdam, Netherlands
Ctr Hosp Univ Porto, Dept Cardiol, Serv Cardiol, Porto, Portugal
:
Univ Germans Trias & Pujol, Barcelona, Spain
Tchetche, D:
Clin Pasteur, Toulouse, France
de Brito, FS:
Univ Sao Paulo Med Sch, Heart Inst, Sao Paulo, Brazil
Barbanti, M:
Policlin G Rodol San Marco, Div Cardiol, Catania, Italy
Kornowski, R:
Rabin Med Ctr, Cardiol Dept, Petah Tiqwa, Israel
Latib, A:
Montefiore Med Ctr, Dept Cardiol, New York, NY USA
Univ Cape Town, Dept Med, Div Cardiol, Cape Town, South Africa
D'Onofrio, A:
Univ Padua, Div Cardiac Surg, Padua, Italy
Ribichini, F:
Univ Verona, Dept Med, Div Cardiol, Verona, Italy
Mainar, V:
Gen Alicante Hosp, Alicante, Spain
Dumonteil, N:
Clin Pasteur, Toulouse, France
Baan, J:
Univ Amsterdam, Amsterdam Univ, Heart Ctr, Dept Clin & Expt Cardiol,Med Ctr, Amsterdam, Netherlands
Abizaid, A:
Univ Sao Paulo Med Sch, Heart Inst, Sao Paulo, Brazil
Sartori, S:
Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA
D'Errigo, P:
Ist Super Sanita, Natl Ctr Global Hlth, Rome, Italy
Tarantini, G:
Univ Padua, Div Cardiac Surg, Padua, Italy
Lunardi, M:
Univ Verona, Dept Med, Div Cardiol, Verona, Italy
Orvin, K:
Rabin Med Ctr, Cardiol Dept, Petah Tiqwa, Israel
Pagnesi, M:
Univ Brescia, ASST Spedali Civili Radiol Sci & Publ Hlth, Inst Cardiol, Dept Med & Surg Specialties, Brescia, Italy
Larraya, GL:
Guipuzcoa Clin, San Sebastian, Spain
Ghattas, A:
Clin Pasteur, Toulouse, France
Dangas, G:
Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA
Mehran, R:
Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10029 USA
Delewi, R:
Univ Amsterdam, Amsterdam Univ, Heart Ctr, Dept Clin & Expt Cardiol,Med Ctr, Amsterdam, Netherlands
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