One-Year Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement: The Gulf TAVR Registry.

Autor: Alasnag M; Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia., AlMerri K; Chest Disease Hospital, Al Shuwaikh, Kuwait city, Kuwait., Almoghairi A; Prince Sultan Cardiac Center, Riyadh, Saudi Arabia., Alenezi A; Chest Disease Hospital, Al Shuwaikh, Kuwait city, Kuwait., Bardooli F; Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain., Al-Sheikh S; Mohammed bin Khalifa Cardiac Centre, Riffa, Bahrain., Alanazi N; King Saud University, Riyadh, Saudi Arabia., AlHarbi W; King Saud University, Riyadh, Saudi Arabia., Al Lawati H; Sultan Qaboos University Hospital, Muscat, Oman., Al Faraidy K; King Fahd Military Medical Complex, Dhahran, Saudi Arabia., AlShehri M; Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Saudi Arabia., Thabane M; Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada., Thabane L; Department of Health research methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada; St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada., Al-Shaibi K; Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia. Electronic address: kfalshaibi@gmail.com.
Jazyk: angličtina
Zdroj: Cardiovascular revascularization medicine : including molecular interventions [Cardiovasc Revasc Med] 2022 Aug; Vol. 41, pp. 19-26. Date of Electronic Publication: 2021 Dec 31.
DOI: 10.1016/j.carrev.2021.12.024
Abstrakt: Background: The use of transcatheter aortic valve replacement (TAVR) is steadily increasing with TAVR procedures offered to patients across the entire spectrum of surgical risks. The Gulf TAVR registry captures the demographics of patients undergoing TAVR in the Gulf region, comorbidities that drive outcomes, procedural success, complications, and one-year outcomes of death or rehospitalization.
Methods: This is a retrospective cohort study for adult patients aged at least 18 years undergoing TAVR at eight centers in the Gulf region. The primary outcome was a composite of death or re-hospitalization at one-year. Secondary outcomes included the individual components of the composite, stroke, and myocardial infarction (MI). We used multivariable Cox regression to determine factors associated with the composite endpoint.
Results: A total of 795 patients (56% male) were included in the final analysis with a mean age of 74.6 (standard deviation (SD) 8.9) years, Society of Thoracic Surgeons Score (STS) Score 4.9 (4.2), ejection fraction of 53% (12.7%). Transfemoral approach was employed in over 95% (762/795). The primary outcomes rate was 12.8% (95% confidence interval [CI]: 10.6-15.4); secondary endpoints were death 5.4% (95% CI 4.0-7.2); stroke 0.8% (95% CI 0.3, 1.7), MI 0.8% (95% CI 0.4-1.9), rehospitalization: 9.3% (95% CI 7.5-11.5) of whom 71.6% were related to cardiovascular causes. 77% of the cardiovascular admissions were attributable to heart failure or the need for pacemaker implantation. Stage IV or V chronic kidney disease was significantly associated with the primary composite endpoint (Hazard Ratio: 2.49, [95% CI: 1.31, 4.73], p = 0.005). Although not significant, paravalvular leak and severe left ventricular dysfunction showed a 2-fold and 3-fold increased risk for the composite endpoint, respectively.
Conclusions: The Gulf TAVR registry is the first of its kind in the region. It profiles an elderly population with a high procedural success rate and a low rate of complications. One-year outcomes were primarily driven by repeat hospitalization for heart failure and pacemaker implantation indicating a need to optimize heart failure management and improve algorithms for the detection of conduction abnormalities.
Competing Interests: Declaration of competing interest None of the authors has any conflicts of interest or relevant financial disclosures.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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