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Published on: November 28, 2018
Impact of Early Hemodynamic Valve Deterioration on Long-Term Outcomes Following Transcatheter Aortic Valve
Antonin Trimaille1, Pedro Cepas-Guillen1, Juan Hernando Del Portillo1
1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
Background:
The incidence, predictors, and impact of early hemodynamic valve deterioration (HVD) after transcatheter aortic valve replacement (TAVR) are unclear.
Objectives:
The aim of this study was to explore the impact of early HVD on long-term clinical outcomes and bioprosthetic durability after TAVR.
Methods:
Data from a prospective single-center registry including all consecutive patients undergoing TAVR between 2007 and 2023 were analyzed. Early HVD was defined as an increase of at least 10 mm Hg in the mean transaortic gradient on echocardiography performed within the first 3 months after TAVR, compared with discharge echocardiography. The primary endpoint was valve-related long-term clinical efficacy according to the Valve Academic Research Consortium 3.
Results:
Among 1,912 patients, early HVD was observed in 68 (3.6%). Smaller annular area (OR per 10-mm2 decrease: 1.03; 95% CI: 1.00-1.08), valve-in-valve procedure (OR: 3.86; 95% CI: 1.95-7.45), and the absence of anticoagulation at discharge (OR: 2.44; 95% CI: 1.28-5.26) were independent predictors of early HVD (P < 0.05 for all). After a median follow-up period of 1,107 days (Q1-Q3: 369-1,697 days), early HVD was independently associated with lower valve-related long-term clinical efficacy (subdistribution HR [sHR]: 0.43; 95% CI: 0.27-0.68; P < 0.001) and a higher risk for stroke (sHR: 3.03; 95% CI: 1.59-5.76; P < 0.001), stage 2 or 3 (sHR: 7.40; 95% CI: 4.51-12.6; P < 0.001) or stage 3 (sHR: 5.43; 95% CI: 2.44-12.1; P < 0.001) bioprosthetic valve deterioration, and bioprosthetic valve failure (sHR: 2.70; 95% CI: 1.30-5.61; P = 0.007). Similar results were observed in a propensity score-matched cohort including 272 patients without and 68 with early HVD.
Conclusions:
Early HVD was associated with worse long-term clinical and hemodynamic outcomes after TAVR. These results highlight the importance of identifying early HVD along with the need for future studies to evaluate the most appropriate treatment for this challenging group of patients.
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