Publication :
Doppler Velocity Index Outcomes Following surgical or Transcatheter Aortic Valve. Replacement in the PARTNER Trials

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Date
2021-06-30
Auteurs
Hahn, Rebecca T.
Douglas, Pamela
Jaber, Wael
Leipsic, Jonathon
Kapadia, Samir R.
Thourani, Vinod H.
Makkar, Rajendra
Susheel, Kodali
Direction de publication
Direction de recherche
Titre de la revue
ISSN de la revue
Titre du volume
Éditeur
ScienceDirect
Projets de recherche
Structures organisationnelles
Numéro de revue
Résumé
Objectives: The aim of this study was to assess the association between Doppler velocity index (DVI) and 2-year outcomes for balloon-expandable SAPIEN 3 transcatheter aortic valve replacement (TAVR) and for surgical aortic valve replacement (SAVR). Background: DVI >0.35 is normal for a prosthetic valve, but recent studies suggest that DVI <0.50 is associated with poor outcomes following TAVR. Methods: Patients with severe aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valve) 2 (intermediate surgical risk) or PARTNER 3 (low surgical risk) trial undergoing TAVR (n = 1,450) or SAVR (n = 1,303) were included. Patients were divided into 3 DVI groups on the basis of core laboratory-assessed discharge or 30-day echocardiograms: DVILOW (≤0.35), DVIINTERMEDIATE (>0.35 to ≤0.50), and DVIHIGH (>0.50). Two-year outcomes were assessed. Results: Following TAVR, there were no differences among the 3 DVI groups in composite outcomes of death, stroke, or rehospitalization or in any individual components of 2-year outcomes (P > 0.70 for all). Following SAVR, there was no difference among DVI groups in the composite outcome (P = 0.27), but there was a significant association with rehospitalization (P = 0.02). Restricted cubic-spline analysis for combined outcomes showed an increased risk with post-SAVR DVI ≤0.35 but no relationship post-TAVR. DVI ≤0.35 was associated with increased 2-year composite outcome for SAVR (HR: 1.81; 95% CI: 1.29-2.54; P < 0.001), with no adverse outcomes for TAVR (P = 0.86). Conclusions: In intermediate- and low-risk cohorts of the PARTNER trials, DVI ≤0.35 predicted worse 2-year outcomes following SAVR, driven primarily by rehospitalization, with no adverse outcomes associated with DVI following TAVR with the balloon-expandable SAPIEN 3 valve.
Description
Revue
JACC. Cardiovascular interventions, Vol. 14 (14), 1594-1606 (2021)
DOI
10.1016/j.jcin.2021.04.007
URL vers la version publiée
Mots-clés
Doppler velocity index , Echocardiography , Surgical aortic valve replacement , Transcatheter aortic valve replacement.
Citation
Type de document
article de recherche