Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves
Patients with non-paradoxical low-flow–low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation tra...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.991729/full |
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| author | Chiara Fraccaro Giuseppe Tarantini Stefano Rosato Giovanni Baglio Fausto Biancari Fausto Biancari Marco Barbanti Corrado Tamburino Francesco Bedogni Marco Ranucci Gian Paolo Ussia Fulvia Seccareccia Paola D'Errigo |
| author_facet | Chiara Fraccaro Giuseppe Tarantini Stefano Rosato Giovanni Baglio Fausto Biancari Fausto Biancari Marco Barbanti Corrado Tamburino Francesco Bedogni Marco Ranucci Gian Paolo Ussia Fulvia Seccareccia Paola D'Errigo |
| author_sort | Chiara Fraccaro |
| collection | DOAJ |
| description | Patients with non-paradoxical low-flow–low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF ≤50% and mean aortic gradient <40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (n = 389) with those who underwent surgical aortic valve replacement (SAVR, n = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 ± 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 ± 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term. |
| first_indexed | 2024-04-11T10:27:50Z |
| format | Article |
| id | doaj.art-2cb8d50e5cbb459a9525b2ba5b5e1c46 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T10:27:50Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-2cb8d50e5cbb459a9525b2ba5b5e1c462022-12-22T04:29:30ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-10-01910.3389/fcvm.2022.991729991729Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valvesChiara Fraccaro0Giuseppe Tarantini1Stefano Rosato2Giovanni Baglio3Fausto Biancari4Fausto Biancari5Marco Barbanti6Corrado Tamburino7Francesco Bedogni8Marco Ranucci9Gian Paolo Ussia10Fulvia Seccareccia11Paola D'Errigo12Interventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, ItalyInterventional Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, ItalyCentro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, ItalyItalian National Agency for Regional Healthcare Services, Rome, ItalyClinica Montevergine, GVM Care & Research, Mercogliano, ItalyHeart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, FinlandDivision of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, ItalyDivision of Cardiology, A.O.U. Policlinico “G. Rodolico—San Marco”, University of Catania, Catania, ItalyInterventional Cardiology Unit, IRCCS Policlinico San Donato, Milan, ItalyDepartment of Cardiothoracic and Vascular Anesthesia and ICU, IRCCS Policlinico San Donato, Milan, ItalyDepartment of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, ItalyCentro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, ItalyCentro Nazionale per la Salute Globale, National Center for Global Health, Istituto Superiore di Sanità Italiana, Roma, ItalyPatients with non-paradoxical low-flow–low-gradient (LFLG) aortic stenosis (AS) are at increased surgical risk, and thus, they may particularly benefit from transcatheter aortic valve replacement (TAVR). However, data on this issue are still limited and based on the results with older-generation transcatheter heart valves (THVs). The aim of this study was to investigate early and mid-term outcome of TAVR with newer-generation THVs in the setting of LFLG AS. Data for the present analysis were gathered from the OBSERVANT II dataset, a national Italian observational, prospective, multicenter cohort study that enrolled 2,989 consecutive AS patients who underwent TAVR at 30 Italian centers between December 2016 and September 2018, using newer-generation THVs. Overall, 420 patients with LVEF ≤50% and mean aortic gradient <40 mmHg were included in this analysis. The primary outcomes were 1-year all-cause mortality and a combined endpoint including all-cause mortality and hospital readmission due to congestive heart failure (CHF) at 1 year. A risk-adjusted analysis was performed to compare the outcome of LFLG AS patients treated with TAVR (n = 389) with those who underwent surgical aortic valve replacement (SAVR, n = 401) from the OBSERVANT I study. Patients with LFLG AS undergoing TAVR were old (mean age, 80.8 ± 6.7 years) and with increased operative risk (mean EuroSCORE II, 11.5 ± 10.2%). VARC-3 device success was 83.3% with 7.6% of moderate/severe paravalvular leak. Thirty-day mortality was 3.1%. One-year all-cause mortality was 17.4%, and the composite endpoint was 34.8%. Chronic obstructive pulmonary disease (HR 1.78) and EuroSCORE II (HR 1.02) were independent predictors of 1-year mortality, while diabetes (HR 1.53) and class NYHA IV (HR 2.38) were independent predictors of 1-year mortality or CHF. Compared with LFLG AS treated with SAVR, TAVR patients had a higher rate of major vascular complications and permanent pacemaker, while SAVR patients underwent more frequently to blood transfusion, cardiogenic shock, AKI, and MI. However, 30-day and 1-year outcomes were similar between groups. Patients with non-paradoxical LFLG AS treated by TAVR were older and with higher surgical risk compared with SAVR patients. Notwithstanding, TAVR was safe and effective with a similar outcome to SAVR at both early and mid-term.https://www.frontiersin.org/articles/10.3389/fcvm.2022.991729/fulllow-flow–low-gradientaortic stenosistranscatheter aortic valve replacementvalvular heart diseaseleft ventricular dysfunction |
| spellingShingle | Chiara Fraccaro Giuseppe Tarantini Stefano Rosato Giovanni Baglio Fausto Biancari Fausto Biancari Marco Barbanti Corrado Tamburino Francesco Bedogni Marco Ranucci Gian Paolo Ussia Fulvia Seccareccia Paola D'Errigo Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves Frontiers in Cardiovascular Medicine low-flow–low-gradient aortic stenosis transcatheter aortic valve replacement valvular heart disease left ventricular dysfunction |
| title | Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves |
| title_full | Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves |
| title_fullStr | Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves |
| title_full_unstemmed | Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves |
| title_short | Early and mid-term outcome of patients with low-flow–low-gradient aortic stenosis treated with newer-generation transcatheter aortic valves |
| title_sort | early and mid term outcome of patients with low flow low gradient aortic stenosis treated with newer generation transcatheter aortic valves |
| topic | low-flow–low-gradient aortic stenosis transcatheter aortic valve replacement valvular heart disease left ventricular dysfunction |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.991729/full |
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