Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications.

Autor:	Landes U; Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel., Hochstadt A; Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel., Manevich L; Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel., Webb JG; Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital, Vancouver, Canada., Sathananthan J; Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital, Vancouver, Canada., Sievert H; Cardiovascular Center, Frankfurt, Germany., Piayda K; Cardiovascular Center, Frankfurt, Germany., Leon MB; Columbia University Medical Center, New York, NY, USA., Nazif TM; Columbia University Medical Center, New York, NY, USA., Blusztein D; Columbia University Medical Center, New York, NY, USA., Hildick-Smith D; Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK., Pavitt C; Department of Cardiology, Brighton & Sussex University Hospitals NHS Trust, Brighton, UK., Thiele H; Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany., Abdel-Wahab M; Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany., Van Mieghem NM; Erasmus University Medical Center, Rotterdam, The Netherlands., Adrichem R; Erasmus University Medical Center, Rotterdam, The Netherlands., Sondergaard L; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., De Backer O; Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark., Makkar RR; Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA, USA., Koren O; Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, CA, USA., Pilgrim T; Department of Cardiology, University Hospital of Bern, Bern, Switzerland., Okuno T; Department of Cardiology, University Hospital of Bern, Bern, Switzerland., Kornowski R; Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel., Codner P; Rabin Medical Center, Tel-Aviv University, Tel-Aviv, Israel., Finkelstein A; Tel-Aviv Medical Center, Tel-Aviv, Israel., Loewenstein I; Tel-Aviv Medical Center, Tel-Aviv, Israel., Barbash I; The Heart and Vascular Center, Chaim Sheba Medical Center, Tel HaShomer, Israel., Sharon A; The Heart and Vascular Center, Chaim Sheba Medical Center, Tel HaShomer, Israel., De Marco F; Department of Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy., Montorfano M; Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy., Buzzatti N; Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute, Milan, Italy., Latib A; Montefiore Medical Center, New York, NY, USA., Scotti A; Montefiore Medical Center, New York, NY, USA., Kim WK; Kerckhoff Heart Center, Bad Nauheim, Germany., Hamm C; Kerckhoff Heart Center, Bad Nauheim, Germany., Franco LN; Department of Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, IdISSC, Madrid, Spain., Mangieri A; Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS and department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy., Schoels WH; Herzzentrum Duisburg, Duisburg, Germany., Barbanti M; Division of Cardiology, A.O.U. Policlinico 'G. Rodolico-San Marco', Catania, Italy., Bunc M; Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia., Akodad M; Ramsay Santé, Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France., Rubinshtein R; Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel., Danenberg H; Edith Wolfson Medical Center, Cardiology Department, Tel-Aviv University, Holon, Israel.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2023 Apr 17; Vol. 44 (15), pp. 1331-1339.
DOI:	10.1093/eurheartj/ehad146
Abstrakt:	Aims: Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. Methods and Results: A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. The principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure, and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. The most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%), and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug, and 7 (21.9%) after valvuloplasty (P = 0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%), and 2 (5.7%) at 30 days (P = 0.010) and 11 (12.6%), 14 (17.7%), and 4 (11.4%) at 1 year (P = 0.418), after redo-TAVI, plug, and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared with those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); P = 0.007]. Conclusion: This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and the optimal PVR treatment modality require further investigation. Competing Interests: Conflict of interest J.G.W.: consultant to, and has received research funding from, Edwards Lifesciences, Abbott Vascular, and Boston Scientific. W-K.K.: proctor or speaker fees from Boston Scientific, Abbott, Edwards Lifesciences, Medtronic, Meril Life Sciences. M.A-W.: received speaker's honoraria and/or consultancy fees on his behalf from Boston Scientific and Medtronic. M.B.: consultant for Edwards Lifesciences, Medtronic, and Boston Scientific. L.S.: consultant fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, Medtronic, and Symetis. C.H.: Advisory Board Medtronic. J.M. Sinning: speaker honoraria and research grants from Medtronic, Boston Scientific, and Edwards Lifesciences. J.S.: consultant to Edwards Lifesciences. M. Andreas: proctor/consultant/speaker for Edwards, Abbott, and Medtronic, received institutional grants (Edwards, Abbott, Medtronic, and LSI). Dr. M. Guerrero: research grant support from Abbott Vascular and Edwards Lifesciences. F. Castriota: proctor for Medtronic and Boston Scientific. T.N.: consulting or honoraria from Edwards Lifesciences, Medtronic, and Boston Scientific. Consulting and equity with Venus MedTech. T.P.: research grants from Boston Scientific, Edwards Lifesciences, and Biotronik; speaker fees/consultancy fees from Boston Scientific, Medtronic, Abbott, Biotronik, and HighLife SAS. V.C. Babaliaros: consultant to Edwards Lifesciences and equity in transmural system. M.M.: consultant fee from Abbott, Boston, Kardia, and Medtronic. N.V.M.: institutional research grants and consulting fees from Abbott, Boston Scientific, Medtronic, Daiichi Sankyo, and PulseCath BV and institutional research grant support from Edwards Lifesciences. A.L.: institutional research/grant support from Abbott, Boston Scientific, Medtronic, and Edwards Lifesciences; and personal consulting honoraria from Abbott, Edwards Lifesciences and Medtronic. D.H-S.: proctor and advisory to Boston, Medtronic, Edwards Lifesciences, and Abbott. R.M. received grant support from Edwards Lifesciences Corporation; he is a consultant for Abbott Vascular, Cordis, and Medtronic and holds equity in Entourage Medical. All other authors have no conflict of interest to report in relation with this manuscript. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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