Transcatheter Closure or Surgery for Symptomatic Paravalvular Leaks: The Multicenter KISS Registry.

Autor: Güner A; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Kırma C; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Ertürk M; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Türkmen M; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Alıcı G; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Karabay CY; Department of Cardiology Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Uzun F; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Kılıçgedik A; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Gündüz S; Department of Cardiology Bahçeşehir University, Faculty of Medicine Istanbul Turkey., Güler GB; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Kalkan AK; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Özkan B; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Sarı M; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Gürsoy MO; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Tekin M; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Yıldız M; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Can F; Department of Cardiology Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Kırali K; Department of Cardiovascular Surgery Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Fedakar A; Department of Cardiovascular Surgery Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Sarıkaya S; Department of Cardiovascular Surgery Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Aydın Ü; Department of Cardiovascular Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Kahraman S; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., İyigün T; Department of Cardiovascular Surgery Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Aksüt M; Department of Cardiovascular Surgery Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey., Karpuzoğlu E; Department of Cardiovascular Surgery Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Çiloğlu K; Department of Cardiology Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Sungur MA; Department of Cardiology Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital Istanbul Turkey., Tanboğa İH; Department of Cardiology and Biostatistics Istanbul Istanbul Nisantasi University Istanbul Turkey., Özkan M; Department of Cardiology Koşuyolu Kartal Heart Training and Research Hospital Istanbul Turkey.; Ardahan University, Faculty of Health Sciences Ardahan Turkey.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jan 02; Vol. 13 (1), pp. e032262. Date of Electronic Publication: 2023 Dec 29.
DOI: 10.1161/JAHA.123.032262
Abstrakt: Background: The optimal treatment of symptomatic paravalvular leak (PVL) remains controversial between transcatheter closure (TC) and surgery. This large-scale study aimed to retrospectively evaluate the long-term outcomes of the patients who underwent reoperation or TC of PVLs.
Methods and Results: A total of 335 (men, 209 [62.4%]; mean age, 58.15±12.77 years) patients who underwent treatment of PVL at 3 tertiary centers between January 2002 and December 2021 were included. Echocardiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary end point was defined as the all-cause death during follow-up. The regression models were adjusted by applying the inverse probability weighted approach to reduce treatment selection bias. The initial management strategy was TC in 171 (51%) patients and surgery in 164 (49%) cases. Three hundred cases (89.6%) had mitral PVL, and 35 (10.4%) had aortic PVL. The mean left ventricular ejection fraction was 52.03±10.79%. Technical (78.9 versus 76.2%; P =0.549) and procedural success (73.7 versus 65.2%; P =0.093) were similar between both groups. In both univariate and multivariable logistic regression analysis, the in-hospital mortality rate in the overall population was significantly higher (15.9 versus 4.7%) in the surgery group compared with the TC group (unadjusted odds ratio, 3.13 [95% CI, 1.75-5.88]; P =0.001; and adjusted odds ratio (inverse probability-weighted), 4.55 [95% CI, 2.27-10.0]; P <0.001). However, the long-term mortality rate in the overall population did not differ between the surgery group and the TC group (unadjusted hazard ratio [HR], 0.86 [95% CI, 0.59-1.25]; P =0.435; and adjusted HR (inverse probability-weighted), 1.11 [95% CI, 0.67-1.81]; P =0.679).
Conclusions: The current data suggest that percutaneous closure of PVL was associated with lower early and comparable long-term mortality rates compared with surgery.
Databáze: MEDLINE
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