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

Authors: Hahn, Rebecca T.; Douglas, Pamela; Jaber, Wael; Leipsic, Jonathon; Kapadia, Samir R.; Thourani, Vinod H.; Makkar, Rajendra; Susheel, Kodali; Clavel, Marie-Annick; Khalique, Omar K.; Weissman, Neil J.; Blanke, Philipp; Chen, Yanjun; Smith, Craig R.; Mack, Michael J.; Leon, Martin B.; Pibarot, Philippe
Abstract: 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.
Document Type: Article de recherche
Issue Date: 30 June 2021
Open Access Date: Restricted access
Document version: VoR
This document was published in: JACC. Cardiovascular interventions, Vol. 14 (14), 1594-1606 (2021)
Alternative version: 10.1016/j.jcin.2021.04.007
Collection:Articles publiés dans des revues avec comité de lecture

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