Transcatheter aortic valve replacement outcomes in bicuspid compared to trileaflet aortic valves

Autor: Chun Shing Kwok, William M. Suh, Mamas A. Mamas, Sara C. Martinez, Vinayak Nagaraja, Rodrigo Bagur, James Nolan, Adrian P. Banning, David L. Fischman, Karim Ratib, Jessica Potts
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Time Factors
Databases
Factual
Transcatheter aortic
medicine.medical_treatment
Heart Valve Diseases
030204 cardiovascular system & hematology
Risk Assessment
law.invention
Transcatheter Aortic Valve Replacement
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Bicuspid Aortic Valve Disease
Randomized controlled trial
Valve replacement
Risk Factors
law
Internal medicine
medicine
Humans
Hospital Mortality
030212 general & internal medicine
Prospective cohort study
Stroke
Contraindication
Aged
Aged
80 and over
business.industry
Aortic Valve Stenosis
General Medicine
Length of Stay
Middle Aged
medicine.disease
Comorbidity
United States
Treatment Outcome
Aortic Valve
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Major bleeding
Zdroj: Cardiovascular Revascularization Medicine. 20:50-56
ISSN: 1553-8389
DOI: 10.1016/j.carrev.2018.09.013
Popis: Aim TAVR in patients with bicuspid aortic valves (BAV) is more challenging compared to individuals with trileaflet aortic valves (TAV). BAV have been excluded from the large randomized clinical trials assessing transcatheter aortic valve replacements (TAVR) and has been considered as a relative contraindication to TAVR. To report the outcomes of TAVR in BAV and compare them to TAV in the National Inpatient Sample (NIS). Methods and results TAVR procedures were identified between 2011 and 2014 in the NIS dataset. Endpoints assessed included in-hospital mortality, periprocedural complications, length of stay and cost. Of 40,604 identified TAVR procedures, 407 (1%) were BAV and the 40,197 (99%) were TAV. Patients with BAV were younger and had a lower comorbidity burden. In hospital mortality (4.89% vs 4.17%, OR: 1.71, 95%CI: 0.57–5.12, P = 0.21), AMI (3.49% vs 3.58%, OR: 1.12, 95%CI: 0.36–3.54, P = 0.85), stroke and TIA (2.49% vs 3.55%, OR: 0.75, 95%CI: 0.18–3.16, P = 0.70), vascular complications (2.39% vs 5.58%, OR:0.47, 95%CI: 0.11–1.93, P = 0.29), major bleeding (16.96% vs 23.50%, OR: 0.63, 95%CI: 0.34–1.17, P = 0.15) and rates of permanent pacemaker (PPM) (9.88% vs 10.88%, OR: 1.19, 95%CI: 0.57–2.51, P = 0.64) were similar in both cohorts. Conclusions With multimodality imaging and further improvement in technology, our study demonstrates off-label TAVR should not be considered prohibitive and can be successfully performed for BAV with similar peri-procedural outcomes compared to those with TAV. However, there is a need for robust large prospective studies.
Databáze: OpenAIRE
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