AI Article Synopsis
Article Abstract
Background: Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups.
Methods: A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke.
Results: The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (=0.002) and normal-flow-LG: 32.1% (=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group.
Conclusions: The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1161/CIRCINTERVENTIONS.119.008792 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Early safety after TAVR according to VARC-3 criteria: incidence, predictors, and clinical impact.
Rev Esp Cardiol (Engl Ed)
December 2024
Département de Cardiologie, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec, Canada. Electronic address:
Introduction And Objectives: The Valve Academic Research Consortium (VARC)-3 definition of the early safety (ES) composite endpoint after transcatheter aortic valve replacement (TAVR) lacks clinical validation. The aim of this study was to determine the incidence, predictors, and clinical impact of ES after TAVR as defined by VARC-3 criteria.
Methods: We performed a multicenter study including 10 078 patients with severe aortic stenosis undergoing transarterial TAVR.
CT-Guided Delayed Valvuloplasty for Post-TAVR Elevated Aortic Gradient.
JACC Cardiovasc Interv
December 2024
Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, RGDS (Ramsay Generale De Santé), Massy, France. Electronic address:
End of Life After Transcatheter Aortic Valve Replacement: A Danish Nationwide Cohort Study.
JACC Cardiovasc Interv
December 2024
Department of Cardiology, The Heart Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
Background: Survival after transcatheter aortic valve replacement (TAVR) has markedly increased. Thus, other comorbidities will intersect patient trajectories and challenge follow-up.
Objectives: The aim of this study was to describe patient characteristics and hospitalizations at end of life to further improve the quality of life for patients undergoing TAVR.
Femoral or Radial Secondary Access in TAVR: A Subanalysis From the Multicenter PULSE Registry.
JACC Cardiovasc Interv
December 2024
Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Population Health Innovation, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Lübeck, Germany; BG University Hospital Bergmannsheil, Bochum, Germany.
Background: Transradial secondary access (TR-SA) may serve as an alternative to the traditional femoral secondary access (TF-SA) for pigtail placement in transcatheter aortic valve replacement (TAVR).
Objectives: The aim of this study was to assess the incidence of secondary access-related vascular complications after TR-SA or TF-SA in TAVR.
Methods: The PULSE (Plug or sUture based vascuLar cloSurE after TAVR) registry retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVR at 10 heart centers from 2016 to 2021.
New wearable cardiac acoustic monitoring technology for evaluation of subclinical leaflet thrombosis after transcatheter aortic valve replacement.
Heart
December 2024
Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
Background: Subclinical leaflet thrombosis (SLT) is a common complication after transcatheter aortic valve replacement (TAVR). Multidimensional CT (MDCT) is the main imaging mortality for the diagnosis of SLT but it enhances the risk of contrast-induced nephropathy. Our study aimed to use an innovative wearable acoustic cardiography (ACG) device to diagnose SLT as an alternative option.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!