Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement: An Analysis of the PARTNER 2 Trial and Registry
Autor: | Josep Rodés-Cabau, Vinod H. Thourani, Erwan Salaun, Pamela S. Douglas, Wael A. Jaber, Philipp Blanke, Zachary M. Gertz, Neil J. Weissman, Geraldine Ong, Martin B. Leon, D. Craig Miller, Oumhani Toubal, Rajendra Makkar, Marie-Annick Clavel, Mohamed Salah Annabi, Abdellaziz Dahou, Carine Ridard, Yiran Zhang, L. Leonardo Rodriguez, Philippe Pibarot, Maria Alu, Mathieu Bernier, Jonathon Leipsic, Federico M. Asch, Rebecca T. Hahn, Howard C. Herrmann, Brian R. Lindman, John G. Webb, Jonathan Beaudoin |
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Rok vydání: | 2020 |
Předmět: |
Aortic valve
Male medicine.medical_specialty Time Factors Patient Readmission Risk Assessment Severity of Illness Index Ventricular Function Left Postoperative Complications Aortic valve replacement Risk Factors Internal medicine medicine Humans Registries Aged Aged 80 and over Heart Failure Heart Valve Prosthesis Implantation business.industry Hemodynamics Stroke volume Aortic Valve Stenosis Recovery of Function medicine.disease Echocardiography Doppler Stroke Stenosis medicine.anatomical_structure Treatment Outcome Aortic Valve Heart Valve Prosthesis North America Cardiology Female Cardiology and Cardiovascular Medicine business |
Zdroj: | Circulation. Cardiovascular interventions. 13(7) |
ISSN: | 1941-7632 |
Popis: | Background: Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient 2 ) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m 2 ) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups. Methods: A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke. Results: The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% ( P =0.002) and normal-flow-LG: 32.1% ( P =0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% ( P =0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group. Conclusions: The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group. |
Databáze: | OpenAIRE |
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