Transcatheter aortic valve replacement after chest radiation: A propensity-matched analysis.

Autor: Kherallah RY; Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Harrison D; Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA., Preventza O; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA., Silva GV; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Dougherty KG; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Coulter SA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Simpson L; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Strickman NE; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Mortazavi A; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Palaskas N; Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA., Fish RD; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Krajcer Z; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Stainback RF; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Gomez JCP; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA., Livesay JJ; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA., Coselli JS; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA., Koneru S; Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA. Electronic address: koneru@bcm.edu.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2021 Apr 15; Vol. 329, pp. 50-55. Date of Electronic Publication: 2020 Dec 24.
DOI: 10.1016/j.ijcard.2020.12.054
Abstrakt: Background: Chest radiation therapy (CRT) for malignant thoracic neoplasms is associated with development of valvular heart disease years later. As previous radiation exposure can complicate surgical treatment, transcatheter aortic valve replacement (TAVR) has emerged as an alternative. However, outcomes data are lacking for TAVR patients with a history of CRT.
Methods: We conducted a retrospective study of all patients who underwent a TAVR procedure at a single institution between September 2012 and November 2018. Among 1341 total patients, 50 had previous CRT. These were propensity-matched in a 1:2 ratio to 100 patients without history of CRT. Thirty-day adverse events were analyzed with generalized estimating equation models. Overall mortality was analyzed with stratified Cox regression modelling.
Results: Median clinical follow-up was 24 months (interquartile range [IQR], 12-44 months). There was no difference between CRT and non-CRT patients in overall mortality (hazard ratio [HR] 0.84 [0.37-1.90], P = 0.67), 30-day mortality (HR 3.1 [0.49-20.03], P = 0.23), or 30-day readmission rate (HR 1.0 [0.43-2.31], P = 1). There were no differences in the rates of most adverse events, but patients with CRT history had higher rates of postprocedural respiratory failure (HR 3.63 [1.32-10.02], P = 0.01) and permanent pacemaker implantation (HR 2.84 [1.15-7.01], P = 0.02).
Conclusions: For patients with aortic valve stenosis and previous CRT, TAVR is safe and effective, with outcomes similar to those in the general aortic stenosis population. Patients with history of CRT are more likely to have postprocedural respiratory failure and to require permanent pacemaker implantation.
Competing Interests: Declaration of Competing Interest Dr. Preventza serves as a consultant for W. L. Gore and Associates and for Terumo Aortic. She has also received travel expenses paid by Medtronic, Inc., and Cook Medical in the past. Dr. Coselli consults for, receives royalties and a departmental educational grant from, and participates in clinical trials for Terumo Aortic; consults and participates in clinical trials for Medtronic, Inc., and W.L. Gore & Associates; and participates in clinical trials for Abbott Laboratories, Edwards Lifesciences, and CytoSorbents. None of the other authors has any conflicts of interest to declare.
(Copyright © 2020 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: