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Mixed aortic valve disease: association with paravalvular leak and reduced survival after transcatheter aortic valve replacement.
- Source :
-
European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2024 Apr 30; Vol. 25 (5), pp. 718-726. - Publication Year :
- 2024
-
Abstract
- Aims: Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease (MAVD) treated by TAVR is gaining more interest, as those patients represent a more complex cohort as compared with isolated AS. However, concerning long-term outcome for this cohort only, limited data are available. The aim of the study is to assess the prevalence of MAVD in TAVR patients, investigate its association with paravalvular regurgitation (PVR), and analyse its impact on long-term mortality after TAVR.<br />Methods and Results: We conducted a registry-based cohort study using the Vienna TAVR registry, enrolling patients who underwent TAVR at Medical University of Vienna between January 2007 and May 2020 with available transthoracic echocardiography before and after TAVR (n = 880). Data analysis included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) out of 880 patients had ≥ mild aortic regurgitation next to severe AS. MAVD was associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR (n = 168 out of 880: 19.09%) was related to higher mortality compared with the absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). MAVD patients developing ≥ mild PVR after TAVR were also associated with higher mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 1.04-1.62 (P = 0.022).<br />Conclusion: MAVD is prevalent among TAVR patients and presents unique challenges, with increased PVR risk and worse outcomes compared with isolated AS. Long-term survival for MAVD patients, not limited to those developing PVR post-TAVR, is compromised. Earlier intervention before the occurrence of structural myocardial damage or surgical valve replacement might be a potential workaround to improve outcomes.<br />Competing Interests: Conflict of interest: M.A. is a proctor/consultant/speaker (Edwards, Abbott, Medtronic, Boston, AbbVie, Zoll) and received institutional research grants (Edwards, Abbott, Medtronic, LSI). All other authors have no relationships relevant to the contents of this article to disclose.<br /> (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Subjects :
- Humans
Female
Male
Aged, 80 and over
Aged
Aortic Valve Insufficiency diagnostic imaging
Aortic Valve Insufficiency surgery
Aortic Valve Insufficiency mortality
Aortic Valve Stenosis surgery
Aortic Valve Stenosis diagnostic imaging
Aortic Valve Stenosis mortality
Echocardiography
Survival Rate
Retrospective Studies
Austria epidemiology
Severity of Illness Index
Aortic Valve Disease surgery
Aortic Valve Disease diagnostic imaging
Postoperative Complications diagnostic imaging
Postoperative Complications epidemiology
Cohort Studies
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement adverse effects
Transcatheter Aortic Valve Replacement methods
Registries
Subjects
Details
- Language :
- English
- ISSN :
- 2047-2412
- Volume :
- 25
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- European heart journal. Cardiovascular Imaging
- Publication Type :
- Academic Journal
- Accession number :
- 38236149
- Full Text :
- https://doi.org/10.1093/ehjci/jeae005