Hemodynamic durability of transcatheter aortic valves using the updated Valve Academic Research Consortium-2 criteria.

Autor: Kumar A; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Sato K; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Banerjee K; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Narayanswami J; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Betancor J; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Menon V; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Mohananey D; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Anumandla AK; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Sawant AC; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Krishnaswamy A; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Tuzcu EM; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Jaber W; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Mick S; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Svensson LG; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Popović ZB; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Blackstone EH; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio., Kapadia SR; Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Jazyk: angličtina
Zdroj: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions [Catheter Cardiovasc Interv] 2019 Mar 01; Vol. 93 (4), pp. 729-738. Date of Electronic Publication: 2018 Oct 12.
DOI: 10.1002/ccd.27927
Abstrakt: Objectives: We investigated the hemodynamic durability of the transcatheter aortic valves (TAVs) using the updated Valve Academic Research Consortium-2 (VARC-2) criteria.
Background: The updated VARC-2 consensus criteria combine flow-dependent and flow-independent echocardiographic parameters for hemodynamic assessment of TAVR. Data on the hemodynamic durability of TAV and clinical risk factors associated with valve hemodynamic deterioration (VHD) are lacking.
Methods: All patients (n = 276) who received TAV between 2006 and 2012 and had ≥2 follow-up echocardiograms were studied.
Results: During a median follow up period of 3.3 (1.8-4.4) years, 8 patients (3%) developed moderate to severe valve stenosis per the VARC-2 criteria, while 20 had mild stenosis. In a Cox proportional hazards model analysis, moderate to severe stenosis by VARC-2 criteria was associated with younger age (P = 0.03, HR 0.94), absence of dual antiplatelet therapy (DAPT) (P = 0.026, HR 0.18), and lower baseline left ventricular ejection fraction (LVEF) (P = 0.006, HR 0.94). Longitudinal analysis using a mixed effect model showed that presence of stenosis by VARC-2 criteria was associated with an increase in aortic valve mean gradient (P < 0.001, +2.34 mmHg per year). In a subset of 93 patients with analyzable fluoroscopic images, deeper valve implantation was associated with increase in mean gradient (P = 0.004, +0.2 mmHg per year per 1 mm increase in implantation depth).
Conclusion: Despite good hemodynamic durability of TAV, patients with younger age, lower LVEF and those not on DAPT after undergoing a TAV replacement, are at a higher risk for development of VHD.
(© 2018 Wiley Periodicals, Inc.)
Databáze: MEDLINE
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