Rapid deployment versus trans‐catheter aortic valve replacement in intermediate‐risk patients: A propensity score analysis
| Autor: | Vlad Gariboldi, Pierre Deharo, Nicolas Jaussaud, Cecile Amanatiou, Jerome Ferrara, Alizée Porto, Pierre Morera, Frederic Collart, Thomas Cuisset, Alexis Theron, Noémie Resseguier |
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| Přispěvatelé: | Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE) |
| Rok vydání: | 2021 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Catheters [SDV]Life Sciences [q-bio] medicine.medical_treatment Regurgitation (circulation) 030204 cardiovascular system & hematology Prosthesis Design Transcatheter Aortic Valve Replacement 03 medical and health sciences 0302 clinical medicine Aortic valve replacement Valve replacement Risk Factors Internal medicine Humans Medicine Propensity Score Stroke ComputingMilieux_MISCELLANEOUS Aged Aged 80 and over Heart Valve Prosthesis Implantation Ejection fraction business.industry Aortic Valve Stenosis medicine.disease Catheter Stenosis Treatment Outcome 030228 respiratory system Aortic Valve Heart Valve Prosthesis Propensity score matching Cardiology Female Surgery Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of Cardiac Surgery Journal of Cardiac Surgery, 2021, 36 (6), pp.2004-2012. ⟨10.1111/jocs.15483⟩ |
| ISSN: | 1540-8191 0886-0440 |
| DOI: | 10.1111/jocs.15483 |
| Popis: | Background There are insufficient studies comparing rapid deployment aortic valve replacement (RDAVR) and trans-aortic valve replacement (TAVR) in intermediate-risk patients with severe aortic stenosis (AS). Aims We compared 2-year outcomes between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk patients with AS. Methods Inclusion criteria were patients with severe AS at a EuroSCORE II ≥ 4%, who received RDAVR or TAVR implantation and clinical evaluation by the Heart Team. Regression adjustment for the propensity score was used to compare RDAVR and TAVR. Primary outcome was the composite criterion of death, disabling stroke, or rehospitalization. Secondary outcomes major bleeding complications postoperation, paravalvular regurgitation ≥ 2, patient-prosthesis mismatch, and pacemaker implantation. Results A total of 152 patients were included from 2012 to 2018: 48 in the RDAVR group and 104 in the TAVR group. The mean age was 82.7 ± 6.0,51.3% patients were female, the mean EuroSCORE II was 6.03 ± 1.6%, mean baseline LVEF was 56 ± 13%, mean indexed effective orifice area was 0.41 ± 0.1 cm/m2 , and the mean gradient was 51.7 ± 14.7 mmHg. RDAVR patients were younger (79.5 ± 6 years vs. 82.6 ± 6 years; p = .01), and at higher risk (EuroSCORE II, 6.61 ± 1.8% vs. 5.63 ± 1.5%; p = .005), Twenty-two patients (45.99%) in the RDAVR group and 32 (66.67%) in the TAVR group met the composite criterion. Through the 1:1 propensity score matching analysis, there was a significant difference between the groups, favoring RDAVR (HR = 0.58 [95% CI: 0.34-1.00]; p = .04). No differences were observed in terms of patient-prosthesis mismatch (0.83 [0.35-1.94]; p = .67), major bleeding events (1.33 [0.47-3.93]; p = .59), paravalvular regurgitation ≥ 2 (0.33[0-6.28]; p = .46), or pacemaker implantation (0.84 [0.25-2.84]; p = .77) CONCLUSION: RDAVR was associated with better 2-year outcomes than TAVR in intermediate-risk patients with severe symptomatic AS. |
| Databáze: | OpenAIRE |
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