Faculty Collaboration Database

Self-Expanding Valve System for Treatment of Native Aortic Regurgitation by Transcatheter Aortic Valve Implantation (from the STS/ACC TVT Registry). Am J Cardiol 2019 Sep 01;124(5):781-788

Date

07/18/2019

Pubmed ID

31311661

DOI

10.1016/j.amjcard.2019.05.045

Scopus ID

2-s2.0-85068827025 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

Transcatheter aortic valve implantation (TAVI) is approved for treatment of symptomatic aortic stenosis in patients at increased risk for surgical valve replacement, but outcomes data in patients with severe native aortic regurgitation (AR) treated with TAVI remain limited. The objective of this analysis was to evaluate outcomes among patients identified in the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry who underwent TAVI for native AR with a commercially available self-expanding valve system. From January 2014 to December 2017, 230 patients in the TVT Registry underwent TAVI for primary severe native AR using a commercially available self-expanding valve (n = 81, CoreValve; n = 149, Evolut R). For inclusion, AR was either pure or mixed with predominantly moderate/severe AR and mean aortic valve gradient ≤20 mm Hg. Thirty-day outcomes were evaluated using time-to-event methods. Device success was reported in 81.7% of patients (CoreValve, 72.2%; Evolut R, 86.9%; p = 0.0.01). Thirty-day all-cause mortality was 13.3%. All patients presented with moderate/severe AR at baseline; at 30 days, 9.1% of implanted patients with data continued to have moderate and 1.4% severe AR. There was a significant reduction in residual moderate/severe AR from the CoreValve to Evolut R device (19.1% vs 6.3%, p = 0.02). Multivariable analysis revealed factors associated with 30-day all-cause mortality include number of valves used (hazard ratio [HR] 2.361, 1.643 to 3.391, p <0.001), albumin < 3.3 mg/dL (HR 3.358, 1.551 to 7.273, p=0.002), and left ventricular ejection fraction (HR 0.978, 0.957 to 1.000, p = 0.047). Despite higher 30-day all-cause mortality, self-expanding TAVI may be an option in selected patients with AR who have no surgical options.

Author List

Anwaruddin S, Desai ND, Szeto WY, Hermiller JB Jr, Sorajja P, Kodali S, Popma JJ, Giri J, Herrmann HC, Tang GHL, Rame JE, McCarthy FH, Zhang AQ, Reardon MJ

Author

Saif Anwaruddin MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Aged, 80 and over
Aortic Valve Insufficiency
Cause of Death
Female
Heart Valve Prosthesis
Hospital Mortality
Humans
Male
Multivariate Analysis
Prognosis
Proportional Hazards Models
Prosthesis Design
Registries
Retrospective Studies
Risk Assessment
Survival Rate
Transcatheter Aortic Valve Replacement
Treatment Outcome