Incidence, timing, and predictors of valve hemodynamic deterioration after transcatheter aortic valve replacement : multicenter registry

Authors: Del Trigo, Maria; Muñoz, Antonio; Wijeysundera, Harindra C.; Nombela-Franco, Luis; Cheema, Asim; Gutierrez, Enrique; Serra, Vicenç; Kefer, Joelle; Amat Santos, Ignacio J.; Benitez, Luis M.; Mewa, Jumana; Jiménez-Quevedo, Pilar; Alnasser, Sami; Garcia del Blanco, Bruno; Dager, Antonio; Abdul-Jawad Altisent, OmarPuri, RishiCampelo-Parada, FranciscoDahou, AbdellazizParadis, Jean-MichelDumont, ÉricPibarot, PhilippeRodés-Cabau, Josep
Abstract: Background: Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR).Objectives: This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR.Methods: This multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a =10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment.Results: The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD.Conclusions: There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD.
Document Type: Article de recherche
Issue Date: 16 February 2016
Open Access Date: Restricted access
Document version: VoR
This document was published in: Journal of the American College of Cardiology, Vol. 67 (6), 644-655 (2016)
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2015.10.097
Collection:Articles publiés dans des revues avec comité de lecture

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