PMID- 29224637
DCOM- 20171215
LR  - 20171215
IS  - 1097-6744 (Electronic)
IS  - 0002-8703 (Linking)
VI  - 195
DP  - 2018 Jan
TI  - Valve hemodynamic deterioration and cardiovascular outcomes in TAVR: A report
      from the STS/ACC TVT Registry.
PG  - 1-13
LID - S0002-8703(17)30276-4 [pii]
LID - 10.1016/j.ahj.2017.09.005 [doi]
AB  - BACKGROUND: Recent reports of leaflet abnormalities (detected using advanced
      imaging) have raised questions regarding transcatheter aortic valve replacement
      (TAVR) durability. We sought to determine the incidence of valve hemodynamic
      deterioration (VHD) and its association with cardiovascular outcomes. METHODS AND
      RESULTS: Consecutive cases with paired postimplant and follow-up echocardiograms 
      from November 2011 to March 2015 in the STS/ACC TVT Registry were allocated into 
      2 overlapping cohorts: early (paired echocardiograms at 0 and 30 days) and late
      (paired echocardiograms at 30 days and 1 year). VHD was defined as an increase in
      mean aortic valve gradient >/=10 mm Hg. Eighteen-month cardiovascular outcomes
      were determined via linkage with Centers for Medicare & Medicaid Services claims.
      Backwards selection logistic regression was performed to determine predictors of 
      VHD. Among 10,099 TAVRs with paired echocardiograms, the median age was 84 years 
      and 48.7% were female, with Society of Thoracic Surgeons score distributions of
      <8% (61.7%), 8%-15% (28.8%), and >15% (9.5%). The incidence of VHD was 2.1% in
      the early cohort and 2.5% in the late cohort. There was no significant difference
      between those with and without VHD in either cohort in the combined end point of 
      death/stroke/aortic valve reintervention or heart failure hospitalization or
      myocardial infarction. Independent predictors of VHD included chronic lung
      disease, valve-in-valve procedure, 23-mm TAVR valve, severe patient-prosthesis
      mismatch, increasing body mass index, and increasing baseline aortic valve
      gradient. CONCLUSIONS: The incidence of VHD in US clinical practice is low, and
      VHD is not associated with increased cardiovascular events at 18 months. Patient 
      and procedural predictors may help to identify patients at risk for VHD in whom
      surveillance or preventive strategies may be considered.
CI  - Copyright (c) 2017 Elsevier Inc. All rights reserved.
FAU - Vemulapalli, Sreekanth
AU  - Vemulapalli S
AD  - Duke Clinical Research Institute, Durham, NC. Electronic address:
FAU - Holmes, David R Jr
AU  - Holmes DR Jr
AD  - Division of Cardiology, Mayo Clinic, Rochester, MN.
FAU - Dai, David
AU  - Dai D
AD  - Duke Clinical Research Institute, Durham, NC.
FAU - Matsouaka, Roland
AU  - Matsouaka R
AD  - Duke Clinical Research Institute, Durham, NC.
FAU - Mack, Michael J
AU  - Mack MJ
AD  - The Heart Hospital Baylor Plano, Plano, TX.
FAU - Grover, Fred L
AU  - Grover FL
AD  - University of Colorado, Denver, CO.
FAU - Makkar, Raj R
AU  - Makkar RR
AD  - Cedars-Sinai Heart Institute, Los Angeles, CA.
FAU - Thourani, Vinod H
AU  - Thourani VH
AD  - Emory School of Medicine, Atlanta, GA.
FAU - Douglas, Pamela S
AU  - Douglas PS
AD  - Duke Clinical Research Institute, Durham, NC.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170909
PL  - United States
TA  - Am Heart J
JT  - American heart journal
JID - 0370465
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/diagnosis/physiopathology/*surgery
MH  - Echocardiography
MH  - Female
MH  - Follow-Up Studies
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Postoperative Complications/*epidemiology/physiopathology
MH  - *Registries
MH  - Retrospective Studies
MH  - Risk Factors
MH  - *Transcatheter Aortic Valve Replacement
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2017/12/12 06:00
MHDA- 2017/12/16 06:00
CRDT- 2017/12/12 06:00
PHST- 2017/09/06 00:00 [received]
PHST- 2017/09/06 00:00 [accepted]
PHST- 2017/12/12 06:00 [entrez]
PHST- 2017/12/12 06:00 [pubmed]
PHST- 2017/12/16 06:00 [medline]
AID - S0002-8703(17)30276-4 [pii]
AID - 10.1016/j.ahj.2017.09.005 [doi]
PST - ppublish
SO  - Am Heart J. 2018 Jan;195:1-13. doi: 10.1016/j.ahj.2017.09.005. Epub 2017 Sep 9.