Clinical Characteristics and Outcomes of Patients Undergoing 3 Aortic Valve Interventions: The THIRD Multicenter Registry.

Details

Serval ID
serval:BIB_9379BF9CD513
Type
Article: article from journal or magazin.
Collection
Publications
Title
Clinical Characteristics and Outcomes of Patients Undergoing 3 Aortic Valve Interventions: The THIRD Multicenter Registry.
Journal
JACC. Cardiovascular interventions
Author(s)
Tarantini G., Tang GHL, Pilgrim T., Kim W.K., Greenbaum A., Castriota F., Webb J.G., Nombela Franco L., De Backer O., Hartikainen T., Codner P., Koren O., Patel V., Meier D., Tomii D., Ueyama H.A., Paredes-Vázquez J.G., Arturi F., Kornowski R., Makkar R.R., Cardaioli F., Nai Fovino L.
Working group(s)
THIRD Registry Investigators
ISSN
1876-7605 (Electronic)
ISSN-L
1936-8798
Publication state
Published
Issued date
13/01/2025
Peer-reviewed
Oui
Volume
18
Number
1
Pages
103-115
Language
english
Notes
Publication types: Multicenter Study ; Journal Article
Publication Status: ppublish
Abstract
Lifetime treatment of aortic valve disease is a matter of increasing debate. Although the risks of a second aortic valve intervention are recognized, little attention has been given to the challenges of a third.
This study delves into the clinical characteristics, indications, and outcomes of patients undergoing 3 aortic valve interventions.
The THIRD (THree aortIc Reinterventions for valve Disease) registry is a retrospective multicenter, international study of patients who underwent a third procedure on the aortic valve, either surgically or transcatheter-based. Patients undergoing 2 aortic procedures during the same hospital admission were excluded. Baseline characteristics, timing, and mode of bioprosthetic failure, sequence of the procedures, and clinical outcomes were adjudicated according to the Valve Academic Research Consortium criteria.
A total of 51 patients from 11 centers were enrolled in this study. Median follow-up time was 565 (314-1,560) days. Eighteen patients (35%) underwent surgical aortic valve replacement (SAVR), and 33 of 51 patients (65%) underwent transcatheter aortic valve replacement (TAVR) as the third intervention. Mean age was 69 ± 14 years, 20 of 51 patients (39%) were female. STS score was 5.0% (Q1-Q3: 3.3%-7.0%). In all TAVR cases, the indication for the first intervention was severe aortic stenosis, as was the indication in 31 of 45 (69%) of SAVR cases (33% bicuspid). The most prevalent procedure sequence was SAVR-SAVR-TAVR (19/51, 37%), followed by SAVR-SAVR-SAVR (10/51, 20%) and SAVR-TAVR-TAVR (10/51, 20%). TAVR-TAVR-TAVR was performed in 4 of 51 cases (8%). The primary indications for a third intervention included structural valve deterioration (SVD) (39/51, 76%), non-SVD (8/51, 16%), and endocarditis (2/51, 4%). Excluding patients with a mechanical prosthesis, predictors of SAVR as third intervention included a lower STS score (OR: 0.58; 95% CI: 0.34-0.98; P = 0.04) and the presence of moderate or severe prosthesis-patient mismatch (OR: 44.8; 95% CI: 2.41-122.00; P = 0.01). Thirty-day device success was 85% for TAVR and 94% for SAVR.
In the THIRD registry, SVD emerged as the predominant indication for a third aortic valve procedure. The most frequent procedure sequence was SAVR-SAVR-TAVR, whereas TAVR-TAVR-TAVR was less common. Although the short-term outcomes in our selected cohort were favorable, further investigation is needed.
Keywords
Humans, Registries, Female, Male, Treatment Outcome, Aged, Retrospective Studies, Transcatheter Aortic Valve Replacement/adverse effects, Transcatheter Aortic Valve Replacement/instrumentation, Transcatheter Aortic Valve Replacement/mortality, Aortic Valve/surgery, Aortic Valve/diagnostic imaging, Aortic Valve/physiopathology, Risk Factors, Time Factors, Aged, 80 and over, Heart Valve Prosthesis, Middle Aged, Heart Valve Prosthesis Implantation/instrumentation, Heart Valve Prosthesis Implantation/adverse effects, Heart Valve Prosthesis Implantation/mortality, Europe, Aortic Valve Stenosis/surgery, Aortic Valve Stenosis/diagnostic imaging, Aortic Valve Stenosis/physiopathology, Aortic Valve Stenosis/mortality, Bioprosthesis, Postoperative Complications/etiology, Risk Assessment, aortic stenosis, lifetime strategy, redo transcatheter aortic valve replacement, surgical aortic valve replacement, transcatheter aortic valve replacement
Pubmed
Open Access
Yes
Create date
17/01/2025 5:11
Last modification date
24/02/2025 11:37
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