The Impact of Aortic Angulation on Contemporary Transcatheter Aortic Valve Replacement Outcomes.

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Citation: Jacc: Cardiovascular Interventions. 14(11):1209-1215, 2021 06 14.PMID: 34112456Institution: MedStar Heart & Vascular Institute | MedStar Washington Hospital CenterDepartment: Advanced Cardiac Catheterization Research Fellowship | Interventional Cardiology FellowshipForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis | *Heart Valve Prosthesis | *Transcatheter Aortic Valve Replacement | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/su [Surgery] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/su [Surgery] | Fluoroscopy | Hospital Mortality | Humans | Prosthesis Design | Risk Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment OutcomeYear: 2021Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: AA >=48degree has been reported to adversely influence accurate THV deployment, procedural success, fluoroscopy time, and paravalvular leak (PVL) in patients undergoing TAVR with early generation self-expanding (SE) THVs.CONCLUSIONS: AA no longer plays a role with new-generation BE or SE THVs in contemporary TAVR practice. AA >=48degree did not affect procedural success or in-hospital outcomes and should no longer be a consideration when determining THV selection. Copyright (c) 2021. Published by Elsevier Inc.METHODS: A retrospective observational study was conducted among 841 patients across all risk strata who underwent transfemoral TAVR using the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO from 2015 to 2020. The previously published cutoff of 48degree was used to analyze procedural success and in-hospital outcomes according to THV type. Receiver-operating characteristic analysis was performed to investigate the impact of AA on an in-hospital composite outcome (need for >1 THV, more than mild PVL, new permanent pacemaker implantation, stroke, and death).OBJECTIVES: The aim of this study was to investigate whether the degree of aortic angulation (AA) affects outcomes after transcatheter aortic valve replacement (TAVR) using newer-generation transcatheter heart valves (THVs).RESULTS: AA >=48degree did not influence outcomes in patients with BE THVs. Additionally, AA >=48degree did not influence procedural success (99.1% vs. 99.1%; p = 0.980), number of THVs used (1.02 vs. 1.04; p = 0.484), rates of more than mild PVL (0.4% vs. 0%; p = 0.486), new permanent pacemaker implantation (11.8% vs. 17.1%; p = 0.178), in-hospital stroke (3.9% vs. 1.8%; p = 0.298), or in-hospital death (0.4% vs. 0.9%; p = 0.980) in patients with SE THVs. Receiver-operating characteristic analysis demonstrated similar outcomes irrespective of AA, with areas under the curve of 0.5525 for SE THVs and 0.5115 for BE THVs.All authors: Ben-Dor I, Case BC, Gallino PE, Medranda GA, Musallam A, Rappaport H, Rogers T, Satler LF, Waksman R, Zhang COriginally published: Jacc: Cardiovascular Interventions. 14(11):1209-1215, 2021 Jun 14.Fiscal year: FY2021Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-07-19
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 34112456 Available 34112456

Available online through MWHC library: 2008 - present

BACKGROUND: AA >=48degree has been reported to adversely influence accurate THV deployment, procedural success, fluoroscopy time, and paravalvular leak (PVL) in patients undergoing TAVR with early generation self-expanding (SE) THVs.

CONCLUSIONS: AA no longer plays a role with new-generation BE or SE THVs in contemporary TAVR practice. AA >=48degree did not affect procedural success or in-hospital outcomes and should no longer be a consideration when determining THV selection. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: A retrospective observational study was conducted among 841 patients across all risk strata who underwent transfemoral TAVR using the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO from 2015 to 2020. The previously published cutoff of 48degree was used to analyze procedural success and in-hospital outcomes according to THV type. Receiver-operating characteristic analysis was performed to investigate the impact of AA on an in-hospital composite outcome (need for >1 THV, more than mild PVL, new permanent pacemaker implantation, stroke, and death).

OBJECTIVES: The aim of this study was to investigate whether the degree of aortic angulation (AA) affects outcomes after transcatheter aortic valve replacement (TAVR) using newer-generation transcatheter heart valves (THVs).

RESULTS: AA >=48degree did not influence outcomes in patients with BE THVs. Additionally, AA >=48degree did not influence procedural success (99.1% vs. 99.1%; p = 0.980), number of THVs used (1.02 vs. 1.04; p = 0.484), rates of more than mild PVL (0.4% vs. 0%; p = 0.486), new permanent pacemaker implantation (11.8% vs. 17.1%; p = 0.178), in-hospital stroke (3.9% vs. 1.8%; p = 0.298), or in-hospital death (0.4% vs. 0.9%; p = 0.980) in patients with SE THVs. Receiver-operating characteristic analysis demonstrated similar outcomes irrespective of AA, with areas under the curve of 0.5525 for SE THVs and 0.5115 for BE THVs.

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