Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.

Details

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Version: Final published version
Serval ID
serval:BIB_8A3E6DD23C0F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Transcatheter aortic valve implantation in failed bioprosthetic surgical valves.
Journal
Jama : the Journal of the American Medical Association
Author(s)
Dvir D., Webb J.G., Bleiziffer S., Pasic M., Waksman R., Kodali S., Barbanti M., Latib A., Schaefer U., Rodés-Cabau J., Treede H., Piazza N., Hildick-Smith D., Himbert D., Walther T., Hengstenberg C., Nissen H., Bekeredjian R., Presbitero P., Ferrari E., Segev A., de Weger A., Windecker S., Moat N.E., Napodano M., Wilbring M., Cerillo A.G., Brecker S., Tchetche D., Lefèvre T., De Marco F., Fiorina C., Petronio A.S., Teles R.C., Testa L., Laborde J.C., Leon M.B., Kornowski R.
Working group(s)
Valve-in-Valve International Data Registry Investigators
ISSN
1538-3598 (Electronic)
ISSN-L
0098-7484
Publication state
Published
Issued date
2014
Peer-reviewed
Oui
Volume
312
Number
2
Pages
162-170
Language
english
Notes
Publication types: Journal Article Publication Status: ppublish PDF : Research, original investigation
Abstract
IMPORTANCE: Owing to a considerable shift toward bioprosthesis implantation rather than mechanical valves, it is expected that patients will increasingly present with degenerated bioprostheses in the next few years. Transcatheter aortic valve-in-valve implantation is a less invasive approach for patients with structural valve deterioration; however, a comprehensive evaluation of survival after the procedure has not yet been performed.
OBJECTIVE: To determine the survival of patients after transcatheter valve-in-valve implantation inside failed surgical bioprosthetic valves.
DESIGN, SETTING, AND PARTICIPANTS: Correlates for survival were evaluated using a multinational valve-in-valve registry that included 459 patients with degenerated bioprosthetic valves undergoing valve-in-valve implantation between 2007 and May 2013 in 55 centers (mean age, 77.6 [SD, 9.8] years; 56% men; median Society of Thoracic Surgeons mortality prediction score, 9.8% [interquartile range, 7.7%-16%]). Surgical valves were classified as small (≤21 mm; 29.7%), intermediate (>21 and <25 mm; 39.3%), and large (≥25 mm; 31%). Implanted devices included both balloon- and self-expandable valves.
MAIN OUTCOMES AND MEASURES: Survival, stroke, and New York Heart Association functional class.
RESULTS: Modes of bioprosthesis failure were stenosis (n = 181 [39.4%]), regurgitation (n = 139 [30.3%]), and combined (n = 139 [30.3%]). The stenosis group had a higher percentage of small valves (37% vs 20.9% and 26.6% in the regurgitation and combined groups, respectively; P = .005). Within 1 month following valve-in-valve implantation, 35 (7.6%) patients died, 8 (1.7%) had major stroke, and 313 (92.6%) of surviving patients had good functional status (New York Heart Association class I/II). The overall 1-year Kaplan-Meier survival rate was 83.2% (95% CI, 80.8%-84.7%; 62 death events; 228 survivors). Patients in the stenosis group had worse 1-year survival (76.6%; 95% CI, 68.9%-83.1%; 34 deaths; 86 survivors) in comparison with the regurgitation group (91.2%; 95% CI, 85.7%-96.7%; 10 deaths; 76 survivors) and the combined group (83.9%; 95% CI, 76.8%-91%; 18 deaths; 66 survivors) (P = .01). Similarly, patients with small valves had worse 1-year survival (74.8% [95% CI, 66.2%-83.4%]; 27 deaths; 57 survivors) vs with intermediate-sized valves (81.8%; 95% CI, 75.3%-88.3%; 26 deaths; 92 survivors) and with large valves (93.3%; 95% CI, 85.7%-96.7%; 7 deaths; 73 survivors) (P = .001). Factors associated with mortality within 1 year included having small surgical bioprosthesis (≤21 mm; hazard ratio, 2.04; 95% CI, 1.14-3.67; P = .02) and baseline stenosis (vs regurgitation; hazard ratio, 3.07; 95% CI, 1.33-7.08; P = .008).
CONCLUSIONS AND RELEVANCE: In this registry of patients who underwent transcatheter valve-in-valve implantation for degenerated bioprosthetic aortic valves, overall 1-year survival was 83.2%. Survival was lower among patients with small bioprostheses and those with predominant surgical valve stenosis.
Keywords
Adult, Aged, Aged, 80 and over, Aortic Valve/surgery, Aortic Valve Insufficiency/surgery, Aortic Valve Stenosis/surgery, Bioprosthesis, Cardiac Catheterization, Female, Heart Valve Prosthesis Implantation/methods, Humans, Male, Middle Aged, Prosthesis Design, Prosthesis Failure, Registries, Survival Analysis, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
27/07/2014 15:02
Last modification date
20/08/2019 14:49
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