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Incidence, Predictors, and Outcomes of Paravalvular Regurgitation After TAVR in Sievers Type 1 Bicuspid Aortic Valves.
- Source :
-
JACC. Cardiovascular interventions [JACC Cardiovasc Interv] 2024 Jul 22; Vol. 17 (14), pp. 1652-1663. Date of Electronic Publication: 2024 May 14. - Publication Year :
- 2024
-
Abstract
- Background: Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) stenosis is technically challenging and is burdened by an increased risk of paravalvular regurgitation (PVR).<br />Objectives: The aim of this study was to identify the incidence, predictors, and clinical outcomes of PVR after TAVR in Sievers type 1 BAV stenosis.<br />Methods: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVR with current-generation transcatheter heart valves (THVs) in 24 international centers were enrolled. PVR was graded as none/trace, mild, moderate, and severe according to echocardiographic criteria. The endpoint of major adverse events (MAEs), defined as a composite of all-cause death, stroke, or hospitalization for heart failure, was assessed at the last available follow-up.<br />Results: A total of 946 patients were enrolled. PVR occurred in 423 patients (44.7%)-mild, moderate, and severe in 387 (40.9%), 32 (3.4%), and 4 (0.4%) patients, respectively. Independent predictors of moderate or severe PVR were a larger virtual raphe ring perimeter (adjusted OR: 1.07; 95% CI: 1.02-1.13), severe annular or left ventricular outflow tract calcification (adjusted OR: 5.21; 95% CI: 1.45-18.77), a self-expanding valve (adjusted OR: 9.01; 95% CI: 2.09-38.86), and intentional supra-annular THV positioning (adjusted OR: 3.31; 95% CI: 1.04-10.54). At a median follow-up of 1.3 years (Q1-Q3: 0.5-2.4 years), moderate or severe PVR was associated with an increased risk of MAEs (adjusted HR: 2.52; 95% CI: 1.24-5.09).<br />Conclusions: After TAVR with current-generation THVs in Sievers type 1 BAV stenosis, moderate or severe PVR occurred in about 4% of cases and was associated with an increased risk of MAEs during follow-up.<br />Competing Interests: Funding Support and Author Disclosures Dr Aurigemma has reported speaker fees from Abbott, Medtronic, Abiomed, and Terumo. Dr Trani has been involved in advisory board meetings or received speaker fees from Medtronic, Abbott, Terumo, Daiichi-Sankyo, and Abiomed. Dr Adamo has reported speaker honoraria from Abbott Vascular and Edwards Lifesciences. Dr Burzotta has been involved in advisory board meetings or has received speaker fees from Medtronic, Abbott, Terumo, Daiichi-Sankyo, and Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.<br /> (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Risk Factors
Aged
Treatment Outcome
Aged, 80 and over
Incidence
Time Factors
Heart Valve Diseases diagnostic imaging
Heart Valve Diseases surgery
Heart Valve Diseases physiopathology
Europe
Risk Assessment
Prosthesis Design
Odds Ratio
Stroke etiology
Stroke diagnosis
Heart Failure physiopathology
Heart Failure etiology
Heart Failure diagnosis
Retrospective Studies
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement instrumentation
Transcatheter Aortic Valve Replacement mortality
Aortic Valve Insufficiency physiopathology
Aortic Valve Insufficiency diagnostic imaging
Aortic Valve Insufficiency etiology
Aortic Valve Insufficiency surgery
Aortic Valve Stenosis surgery
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis physiopathology
Aortic Valve Stenosis mortality
Aortic Valve surgery
Aortic Valve diagnostic imaging
Aortic Valve physiopathology
Aortic Valve abnormalities
Bicuspid Aortic Valve Disease surgery
Bicuspid Aortic Valve Disease diagnostic imaging
Heart Valve Prosthesis
Severity of Illness Index
Subjects
Details
- Language :
- English
- ISSN :
- 1876-7605
- Volume :
- 17
- Issue :
- 14
- Database :
- MEDLINE
- Journal :
- JACC. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 38749449
- Full Text :
- https://doi.org/10.1016/j.jcin.2024.05.002