MedStar Authors catalog › Details for: Prosthesis-Patient Mismatch in 62,125 Patients Following Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry.
Normal view MARC view ISBD view

Prosthesis-Patient Mismatch in 62,125 Patients Following Transcatheter Aortic Valve Replacement: From the STS/ACC TVT Registry.

by Thourani, Vinod H.
Citation: Journal of the American College of Cardiology. 2018 Sep 18.Journal: Journal of the American College of Cardiology.Published: ; 2018ISSN: 0735-1097.Full author list: Herrmann HC; Daneshvar SA; Fonarow GC; Stebbins A; Vemulapalli S; Desai ND; Malenka DJ; Thourani VH; Rymer J; Kosinski AS.UI/PMID: 30257798.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jacc.2018.09.001 (Click here) Abbreviated citation: J Am Coll Cardiol. 2018 Sep 18.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (AVR) for aortic stenosis is generally associated with worse outcomes. Transcatheter AVR (TAVR) can achieve a larger valve orifice and the effects of PPM after TAVR are less well studied.Abstract: OBJECTIVES: The authors utilized the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) registry to examine the frequency, predictors, and association with outcomes of PPM after TAVR in 62,125 patients enrolled between 2014 and 2017.Abstract: METHODS: On the basis of the discharge echocardiographic effective valve area indexed to body surface area, PPM was classified as severe (<0.65 cm<sup>2</sup>/m<sup>2</sup>), moderate (0.65 to 0.85 cm<sup>2</sup>/m<sup>2</sup>), or none (>0.85 cm<sup>2</sup>/m<sup>2</sup>). Multivariable regression models were utilized to examine predictors of severe PPM as well as adjusted outcomes, including mortality, heart failure (HF) rehospitalization, stroke, and quality of life, at 1 year in 37,470 Medicare patients with claims linkage.Abstract: RESULTS: Severe and moderate PPM were present following TAVR in 12% and 25% of patients, respectively. Predictors of severe PPM included small (<=23-mm diameter) valve prosthesis, valve-in-valve procedure, larger body surface area, female sex, younger age, non-white/Hispanic race, lower ejection fraction, atrial fibrillation, and severe mitral or tricuspid regurgitation. At 1 year, mortality was 17.2%, 15.6%, and 15.9% in severe, moderate, and no PPM patients, respectively (p = 0.02). HF rehospitalization had occurred in 14.7%, 12.8%, and 11.9% of patients with severe, moderate, and no PPM, respectively (p < 0.0001). There was no association of severe PPM with stroke or quality of life score at 1 year.Abstract: CONCLUSIONS: Severe PPM after TAVR was present in 12% of patients and was associated with higher mortality and HF rehospitalization at 1 year. Further investigation is warranted into the prevention of severe PPM in patients undergoing TAVR.Abstract: Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Powered by Koha