Procedural Results of Patients Undergoing Transcatheter Aortic Valve Implantation With Aortic Annuli Diameter ≥26 mm: insights from the German Aortic Valve Registry.

Autor: Piayda K; Division of Cardiology, Pulmonology and Vascular Medicine., Bauer T; Department of Cardiology, General Internal Medicine, Intensive Care, Sana Clinic Offenbach, Offenbach, Germany., Beckmann A; German Society for Thoracic and Cardiovascular Surgery, Berlin, Germany., Bekeredjian R; Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany., Bleiziffer S; Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany; German Center for Cardiovascular Research, Berlin, Germany., Ensminger S; Department of Cardiac Surgery, University of Lübeck, Lübeck, Germany., Frerker C; Department of Cardiology, Vascular Medicine and Intensive Care, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany., Möllmann H; Department of Internal Medicine I, St.-Johannes-Hospital Dortmund, Dortmund, Germany., Walther T; Department of Cardiothoracic Surgery, University Hospital Frankfurt, Frankfurt, Germany; German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany., Balaban Ü; German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany., Herrmann E; German Center for Cardiovascular Research DZHK, Partner Site Rhine-Main, Frankfurt, Germany; Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Frankfurt, Germany., Hamm C; Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Bad Nauheim, Germany., Beyersdorf F; Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany., Lichtenberg A; Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany., Zeus T; Division of Cardiology, Pulmonology and Vascular Medicine. Electronic address: zeus@med.uni-duesseldorf.de., Mehdiani A; Department of Cardiovascular Surgery, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2022 Feb 01; Vol. 164, pp. 111-117. Date of Electronic Publication: 2021 Nov 26.
DOI: 10.1016/j.amjcard.2021.10.021
Abstrakt: Patients presenting with severe aortic stenosis and large aortic annuli are challenging to treat because of the size limitations of available transcatheter heart valves. In this study, we aimed to determine clinical and hemodynamic outcomes in patients presenting with large aortic annuli who underwent transcatheter aortic valve implantation (TAVI). Patients from the German Aortic Valve Registry who underwent TAVI either with the Edwards Sapien (ES) or Medtronic CoreValve (MCV) systems from 2011 to 2017 were included. They were further stratified into a large (aortic annulus diameter 26 to 29 mm for ES; 26 to 30 mm for MCV) and extra-large (aortic annulus diameter >29 mm for ES; >30 mm for MCV) group and analyzed using propensity score adjustment. Extra-large was set beyond the sizing limitations according to the manufacturer's instructions for use. Patients in the large (n = 5,628) and extra-large (n = 509) groups were predominantly male (large: 92.6% vs extra-large: 91.9%). The 30-day mortality was comparable (large: 3.9% vs extra-large: 5.0%, p = 0.458). Procedure duration (large: 78.9 minutes ± 0.82 vs extra-large: 86.4 minutes ± 1.9, p <0.001) was longer in the extra-large group. Likewise, vascular complications (large: 6.2% vs extra-large: 12%, p = 0.002) and the need for a permanent pacemaker implantation (large: 18.8% vs extra-large: 26.0%, p = 0.027) were more often present in the extra-large group. Aortic regurgitation ≥II after valve implantation was numerically higher (large: 3.0% vs extra-large: 5.3%, p = 0.082) in patients with extra-large anatomy. In conclusion, patients with large and extra-large aortic annulus diameters who underwent TAVI have comparable 30-day mortality. Beyond the recommended annulus range, there is a higher risk for vascular complications and permanent pacemaker implantation.
Competing Interests: Disclosures Drs. Piayda and Zeus report statistical analysis was provided by German Center for Cardiovascular Disease. Dr. Frerker reports a relation with Universitätsklinikum Schleswig-Holstein that includes consulting or advisory and has received speaker fees from Medtronic, Edwards Lifesciences, Boston Scientific, and Abbott. Dr. Bleiziffer reports a relation with Heart and Diabetes Center North Rhine-Westphalia that includes consulting or advisory and has received speaker fees from Medtronic and Boston Scientific. Dr. Zeus reports a relation with University Hospital Düsseldorf that includes consulting or advisory and has received consulting fees, travel expenses, or study honoraria from Medtronic and Edwards Lifesciences outside of this work. The remaining authors have no conflicts of interest to declare.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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