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Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry

Authors :
Pierre Deharo
Lionel Leroux
Alexis Theron
Jérome Ferrara
Antoine Vaillier
Nicolas Jaussaud
Alizée Porto
Pierre Morera
Vlad Gariboldi
Bernard Iung
Thierry Lefevre
Philippe Commeau
Margaux Gouysse
Florence du Chayla
Nicolas Glatt
Guillaume Cayla
Herve Le Breton
Hakim Benamer
Sylvain Beurtheret
Jean Philippe Verhoye
Helene Eltchaninoff
Martine Gilard
Jean Philippe Collet
Nicolas Dumonteil
Frederic Collart
Thomas Modine
Thomas Cuisset
Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN)
Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE)
Hôpital de la Timone [CHU - APHM] (TIMONE)
Aix-Marseille Université - École de médecine (AMU SMPM MED)
Aix-Marseille Université - Faculté des sciences médicales et paramédicales (AMU SMPM)
Aix Marseille Université (AMU)-Aix Marseille Université (AMU)
Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte [CHU Bordeaux]
CHU Bordeaux [Bordeaux]
Département de Cardiologie [Hôpital de la Timone - APHM]
Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)
Service de cardiologie [CHU Bichat]
AP-HP - Hôpital Bichat - Claude Bernard [Paris]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot, Sorbonne Paris Cité
Laboratoire de Recherche Vasculaire Translationnelle (LVTS (UMR_S_1148 / U1148))
Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPCité)-Université Sorbonne Paris Nord
Hôpital Privé Jacques Cartier [Massy]
Polyclinique Les Fleurs - ELSAN [Ollioules] (PLF)
Clinityx
Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)
CHU Pontchaillou [Rennes]
Hôpital Saint-Joseph [Marseille]
Service de cardiologie [CHU Rouen]
CHU Rouen
Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN)
Normandie Université (NU)
Hôpital de la Cavale Blanche - CHRU Brest (CHU - BREST )
Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases (ICAN)
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Sorbonne Université (SU)-Institut de Cardiométabolisme et Nutrition = Institute of Cardiometabolism and Nutrition [CHU Pitié Salpêtrière] (IHU ICAN)
CHU Pitié-Salpêtrière [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-CHU Pitié-Salpêtrière [AP-HP]
Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Clinique Pasteur
Clinique Pasteur [Toulouse]
ANR-16-RHUS-0003,STOP-AS,STOP-AS(2016)
Source :
Journal of Clinical Medicine; Volume 11; Issue 20; Pages: 6117, Journal of Clinical Medicine, Journal of Clinical Medicine, 2022, 11 (20), pp.6117. ⟨10.3390/jcm11206117⟩
Publication Year :
2022
Publisher :
Multidisciplinary Digital Publishing Institute, 2022.

Abstract

Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up.

Details

Language :
English
ISSN :
20770383
Database :
OpenAIRE
Journal :
Journal of Clinical Medicine; Volume 11; Issue 20; Pages: 6117
Accession number :
edsair.doi.dedup.....502621efaeccaf70bbe07d7465fdfbca
Full Text :
https://doi.org/10.3390/jcm11206117