Hemodynamic outcomes of transcatheter aortic valve replacement and medical management in severe, inoperable aortic stenosis: a longitudinal echocardiographic study of cohort B of the PARTNER trial.

MedStar author(s):
Citation: Journal of the American Society of Echocardiography. 28(2):210-7.e1-9, 2015 Feb.PMID: 25455544Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Comparative Study | Journal Article | Multicenter Study | Randomized Controlled Trial | Research Support, Non-U.S. Gov'tSubject headings: *Aortic Valve Stenosis/dt [Drug Therapy] | *Aortic Valve Stenosis/su [Surgery] | *Hemodynamics/ph [Physiology] | *Transcatheter Aortic Valve Replacement/mt [Methods] | Age Factors | Aged | Aged, 80 and over | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/us [Ultrasonography] | Cardiac Catheterization/mt [Methods] | Cohort Studies | Echocardiography, Doppler/mt [Methods] | Female | Follow-Up Studies | Humans | Kaplan-Meier Estimate | Longitudinal Studies | Male | Patient Selection | Risk Assessment | Severity of Illness Index | Statistics, Nonparametric | Survival Rate | Transcatheter Aortic Valve Replacement/mo [Mortality] | Treatment OutcomeYear: 2015Local holdings: Available online through MWHC library: 2007 - presentISSN:
  • 0894-7317
Name of journal: Journal of the American Society of Echocardiography : official publication of the American Society of EchocardiographyAbstract: BACKGROUND: Inoperable aortic stenosis may be treated with either transcatheter aortic valve replacement (TAVR) or medical management (MM) with or without balloon aortic valvuloplasty (BAV). The aim of this study was to compare the long-term echocardiographic findings among TAVR, MM, and BAV in patients with severe, inoperable aortic stenosis.CONCLUSIONS: TAVR results in immediate and sustained relief in pressure overload and improved LV systolic function, with continued regression of hypertrophy over 3 years. Poor clinical results with BAV are explained by the modest and transient reductions in pressure overload with BAV, which were not accompanied by improved LV function or remodeling. TAVR is the preferred treatment in eligible inoperable patients (ClinicalTrials.gov identifier NCT00530894).Copyright � 2015. Published by Elsevier Inc.METHODS: A total of 358 inoperable patients in the Placement of Aortic Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core laboratory.RESULTS: At baseline, TAVR and MM were similar, with more frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P = .03) and larger end-systolic volumes (54.5 +/- 29.3 vs 69.1 +/- 48.0 mL, P = .03) in MM. By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8 +/- 14.7 to 10.0 +/- 4.3 mm Hg, P < .001), ejection fraction had increased (from 53.2 +/- 12.4% to 56.7 +/- 10.0%, P < .001), and left ventricular (LV) mass index had decreased (from 144.7 +/- 36.1 to 140.0 +/- 37.9 gm/m(2), P < .05). After 1 year, aortic valve gradients and area were unchanged, while LV mass index had decreased by another 16 gm/m(2) (to 124 gm/m(2)). By 30 days after BAV, mean aortic valve gradient had decreased from 43.4 +/- 15.0 to 31.9 +/- 11.1 mm Hg, while ejection fraction and LV mass index were unchanged; gradient reverted to baseline at 1 year. No changes in gradients or mass were seen in MM patients.All authors: Douglas PS, Gopal D, Hahn RT, Keane MG, Leon MB, Lerakis S, Pibarot P, Siegel R, Smith CR, Stewart WJ, Svensson LG, Thompson C, Tuzcu EM, Wang Z, Weissman NJ, Xu KFiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-01-13
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 25455544 Available 25455544

Available online through MWHC library: 2007 - present

BACKGROUND: Inoperable aortic stenosis may be treated with either transcatheter aortic valve replacement (TAVR) or medical management (MM) with or without balloon aortic valvuloplasty (BAV). The aim of this study was to compare the long-term echocardiographic findings among TAVR, MM, and BAV in patients with severe, inoperable aortic stenosis.

CONCLUSIONS: TAVR results in immediate and sustained relief in pressure overload and improved LV systolic function, with continued regression of hypertrophy over 3 years. Poor clinical results with BAV are explained by the modest and transient reductions in pressure overload with BAV, which were not accompanied by improved LV function or remodeling. TAVR is the preferred treatment in eligible inoperable patients (ClinicalTrials.gov identifier NCT00530894).Copyright � 2015. Published by Elsevier Inc.

METHODS: A total of 358 inoperable patients in the Placement of Aortic Transcatheter Valves trial were randomized to MM or TAVR. Echocardiograms obtained at baseline, 30 days, and 1, 2, and 3 years were analyzed by a central core laboratory.

RESULTS: At baseline, TAVR and MM were similar, with more frequent Society of Thoracic Surgeons score > 10 (51.7% vs 65.0%, P = .03) and larger end-systolic volumes (54.5 +/- 29.3 vs 69.1 +/- 48.0 mL, P = .03) in MM. By 30 days after TAVR, mean aortic valve gradient had decreased (from 43.8 +/- 14.7 to 10.0 +/- 4.3 mm Hg, P < .001), ejection fraction had increased (from 53.2 +/- 12.4% to 56.7 +/- 10.0%, P < .001), and left ventricular (LV) mass index had decreased (from 144.7 +/- 36.1 to 140.0 +/- 37.9 gm/m(2), P < .05). After 1 year, aortic valve gradients and area were unchanged, while LV mass index had decreased by another 16 gm/m(2) (to 124 gm/m(2)). By 30 days after BAV, mean aortic valve gradient had decreased from 43.4 +/- 15.0 to 31.9 +/- 11.1 mm Hg, while ejection fraction and LV mass index were unchanged; gradient reverted to baseline at 1 year. No changes in gradients or mass were seen in MM patients.

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