Transcatheter aortic valve implantation in failed bioprosthetic surgical valves
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Transcatheter aortic valve implantation in failed bioprosthetic surgical valves. / Dvir, Danny; Webb, John G; Bleiziffer, Sabine; Pasic, Miralem; Waksman, Ron; Kodali, Susheel; Barbanti, Marco; Latib, Azeem; Schaefer, Ulrich; Rodés-Cabau, Josep; Treede, Hendrik; Piazza, Nicolo; Hildick-Smith, David; Himbert, Dominique; Walther, Thomas; Hengstenberg, Christian; Nissen, Henrik; Bekeredjian, Raffi; Presbitero, Patrizia; Ferrari, Enrico; Segev, Amit; de Weger, Arend; Windecker, Stephan; Moat, Neil E; Napodano, Massimo; Wilbring, Manuel; Cerillo, Alfredo G; Brecker, Stephen; Tchetche, Didier; Lefèvre, Thierry; De Marco, Federico; Fiorina, Claudia; Petronio, Anna Sonia; Teles, Rui C; Testa, Luca; Laborde, Jean-Claude; Leon, Martin B; Kornowski, Ran; Valve-in-Valve International Data Registry Investigators.
in: JAMA-J AM MED ASSOC, Jahrgang 312, Nr. 2, 07.2014, S. 162-170.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Transcatheter aortic valve implantation in failed bioprosthetic surgical valves
AU - Dvir, Danny
AU - Webb, John G
AU - Bleiziffer, Sabine
AU - Pasic, Miralem
AU - Waksman, Ron
AU - Kodali, Susheel
AU - Barbanti, Marco
AU - Latib, Azeem
AU - Schaefer, Ulrich
AU - Rodés-Cabau, Josep
AU - Treede, Hendrik
AU - Piazza, Nicolo
AU - Hildick-Smith, David
AU - Himbert, Dominique
AU - Walther, Thomas
AU - Hengstenberg, Christian
AU - Nissen, Henrik
AU - Bekeredjian, Raffi
AU - Presbitero, Patrizia
AU - Ferrari, Enrico
AU - Segev, Amit
AU - de Weger, Arend
AU - Windecker, Stephan
AU - Moat, Neil E
AU - Napodano, Massimo
AU - Wilbring, Manuel
AU - Cerillo, Alfredo G
AU - Brecker, Stephen
AU - Tchetche, Didier
AU - Lefèvre, Thierry
AU - De Marco, Federico
AU - Fiorina, Claudia
AU - Petronio, Anna Sonia
AU - Teles, Rui C
AU - Testa, Luca
AU - Laborde, Jean-Claude
AU - Leon, Martin B
AU - Kornowski, Ran
AU - Valve-in-Valve International Data Registry Investigators
PY - 2014/7
Y1 - 2014/7
N2 - 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.
AB - 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.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Aortic Valve/surgery
KW - Aortic Valve Insufficiency/surgery
KW - Aortic Valve Stenosis/surgery
KW - Bioprosthesis
KW - Cardiac Catheterization
KW - Female
KW - Heart Valve Prosthesis Implantation/methods
KW - Humans
KW - Male
KW - Middle Aged
KW - Prosthesis Design
KW - Prosthesis Failure
KW - Registries
KW - Survival Analysis
KW - Treatment Outcome
U2 - 10.1001/jama.2014.7246
DO - 10.1001/jama.2014.7246
M3 - SCORING: Journal article
C2 - 25005653
VL - 312
SP - 162
EP - 170
JO - JAMA-J AM MED ASSOC
JF - JAMA-J AM MED ASSOC
SN - 0098-7484
IS - 2
ER -