Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement: Multicenter Registry
Maria Del Trigo, Antonio J Muñoz-Garcia, Harindra C Wijeysundera, Luis Nombela-Franco, Asim N Cheema, Enrique Gutierrez, Vicenç Serra, Joelle Kefer, Ignacio J Amat-Santos, Luis M Benitez, Jumana Mewa, Pilar Jiménez-Quevedo, Sami Alnasser, Bruno Garcia Del Blanco, Antonio Dager, Omar Abdul-Jawad Altisent, Rishi Puri, Francisco Campelo-Parada, Abdellaziz Dahou, Jean-Michel Paradis, Eric Dumont, Philippe Pibarot, Josep Rodés-Cabau, Maria Del Trigo, Antonio J Muñoz-Garcia, Harindra C Wijeysundera, Luis Nombela-Franco, Asim N Cheema, Enrique Gutierrez, Vicenç Serra, Joelle Kefer, Ignacio J Amat-Santos, Luis M Benitez, Jumana Mewa, Pilar Jiménez-Quevedo, Sami Alnasser, Bruno Garcia Del Blanco, Antonio Dager, Omar Abdul-Jawad Altisent, Rishi Puri, Francisco Campelo-Parada, Abdellaziz Dahou, Jean-Michel Paradis, Eric Dumont, Philippe Pibarot, Josep Rodés-Cabau
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.
Keywords: anticoagulation therapy; transcatheter aortic valve replacement; valve degeneration; valve-in-valve.
Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed