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Am J Cardiol. 2015 May 1;115(9):1273-80. doi: 10.1016/j.amjcard.2015.01.560. Epub 2015 Feb 12.

Comparison of outcomes after one-versus-two transcatheter aortic valve implantation during a same procedure (from the FRANCE2 Registry).

Author information

1
Cardiology Department, University Hospital Clermont, Ferrand, France. Electronic address: gclerfond@chu-clermontferrand.fr.
2
Cardiology Department, University Hospital Clermont, Ferrand, France.
3
Cardiology Department, University Hospital, Brest, France.
4
Cardiovascular and Thoracic Surgery Department, University Hospital, Limoges, France.
5
Cardiology Department, University Hospital, Rouen, France.
6
Cardiology Department, University Hospital Bichat, Paris, France.
7
Cardiovascular and Thoracic Surgery Department, University Hospital Pitié-Salpêtrière, Paris, France.
8
Cardiology Department, University Hospital Henri-Mondor, Paris, France.
9
URC-ECO, Paris, France.
10
Cardiovascular and Thoracic Surgery Department, University Hospital, Lille, France.
11
Pharmacology Department, University Hospital, Lyon, France.
12
Cardiovascular and Thoracic Surgery Department, University Hospital, Rennes, France.
13
Cardiovascular and Thoracic Surgery Department, Hospital Jacques Cartier, Massy, France.
14
Cardiology Department, Clinique Pasteur, Toulouse, France.

Abstract

Analysis of the causes, outcomes, and mortality of patients with severe symptomatic aortic stenosis requiring the implantation of 2 valves during transcatheter aortic valve implantation was conducted from the French Aortic National CoreValve and Edwards 2 (FRANCE2) registry. Pre- and postprocedural data from 3,919 patients from January 2010 to December 2011 (CoreValve or Edwards) were collated and analyzed. Characteristics of patients requiring immediate second valve procedures were compared with those of the other patients. The 72 patients (1.8%) who underwent implantation of a second valve were studied. Indications were device malpositioning (72%) and embolization (28%). Clinical and echocardiographic characteristics of patients receiving 2 valves were comparable with those of the other patients. The 2-year survival rate was 51.7% for patients with 2 valves as opposed to 62.3% for those with 1 valve (p<0.001). The need for a second valve was an independent predictor of all-cause (hazard ratio 2.32, 95% confidence interval 1.50 to 3.60, p<0.001) and cardiovascular (hazard ratio 2.64, 95% confidence interval 1.35 to 5.15, p<0.001) mortality at 2 years. During follow-up, clinical and echocardiographic data remained similar between the 2 groups. In conclusion, in the FRANCE2 study, the main causes for second valve implantation during the same procedure were malpositioning and embolization. Although the procedure was feasible, it was accompanied by excess mortality. Valve hemodynamic status was preserved during the course of follow-up.

PMID:
25791239
DOI:
10.1016/j.amjcard.2015.01.560
[Indexed for MEDLINE]

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