Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial.

MedStar author(s):
Citation: Jacc: Cardiovascular Interventions. 10(23):2414-2422, 2017 Dec 11PMID: 29217004Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/su [Surgery] | *Transcatheter Aortic Valve Replacement/mo [Mortality] | *Ventricular Dysfunction, Left/pp [Physiopathology] | *Ventricular Function, Left | Aged | Aged, 80 and over | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/pp [Physiopathology] | Chi-Square Distribution | Clinical Decision-Making | Echocardiography | Female | Humans | Kaplan-Meier Estimate | Linear Models | Male | Propensity Score | Proportional Hazards Models | Recovery of Function | Registries | Risk Assessment | Risk Factors | Severity of Illness Index | Stroke Volume | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Transcatheter Aortic Valve Replacement/mt [Methods] | Treatment Outcome | Ventricular Dysfunction, Left/dg [Diagnostic Imaging] | Ventricular Dysfunction, Left/mo [Mortality]Year: 2017Local holdings: Available online through MWHC library: 2008 - presentISSN:
  • 1936-8798
Name of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: LV injury inherent to TA access for structural heart disease interventions may be particularly detrimental to the LV, functional recovery, and survival in patients with LV dysfunction.CONCLUSIONS: Compared with TF TAVR, TA TAVR is associated with a disproportionate risk of cardiac mortality in patients with LV dysfunction and with delayed and less robust improvement in LV function and overall functional status. Caution is warranted when considering TA access for structural heart disease interventions, particularly in patients with LV dysfunction. (Placement of Aortic Transcatheter Valves [PARTNER]; NCT00530894).Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: The study included patients enrolled within the PARTNER I (Placement of Aortic Transcatheter Valves) trial that underwent transfemoral (TF) or TA TAVR. Analyses of clinical outcomes were stratified by the presence of baseline LV dysfunction (LVEF<50%) and adjusted for the propensity of receiving TA TAVR.OBJECTIVES: The authors sought to evaluate the impact of transapical (TA) transcatheter aortic valve replacement (TAVR) on mortality, left ventricular (LV) ejection fraction (LVEF) improvement, and functional recovery in patients with LV dysfunction.RESULTS: Of 2,084 subjects, 1,057 underwent TA TAVR. TA access was associated with increased 2-year all-cause mortality in those with (adjusted hazard ratio [HR<sub>adjusted</sub>]: 1.52; 95% confidence interval [CI]: 1.12 to 2.07; p = 0.008) and without (HR<sub>adjusted</sub>: 1.38; 95% CI: 1.10 to 1.74; p = 0.006) LV dysfunction. TA TAVR portended increased 2-year cardiac mortality in subjects with LVEF<50% (HR<sub>adjusted</sub>: 1.92; 95% CI: 1.21 to 3.05; p = 0.006), but not with LVEF>=50% (HR<sub>adjusted</sub>: 1.29; 95% CI: 0.87 to 1.90; p = 0.21). In those with LVEF<50%, greater improvements in LVEF (TF-TA difference +4.04%, 95% CI: 2.39% to 5.69%; p < 0.0001) and 6-min walk distance (TF-TA difference +45.1 m, 95% CI: 18.4 to 71.9 m; p = 0.001) occurred within 30 days after TF versus TA TAVR.All authors: Alu MC, Crowley A, Douglas PS, Elmariah S, Fearon WF, Hahn RT, Inglessis I, Kodali S, Leon MB, Lindman BR, Miller DC, Palacios IF, PARTNER Trial Investigators and PARTNER Publications Office, Passeri JJ, Pibarot P, Svensson L, Thourani VH, Vlahakes GJFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2017-12-12
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29217004 Available 29217004

Available online through MWHC library: 2008 - present

BACKGROUND: LV injury inherent to TA access for structural heart disease interventions may be particularly detrimental to the LV, functional recovery, and survival in patients with LV dysfunction.

CONCLUSIONS: Compared with TF TAVR, TA TAVR is associated with a disproportionate risk of cardiac mortality in patients with LV dysfunction and with delayed and less robust improvement in LV function and overall functional status. Caution is warranted when considering TA access for structural heart disease interventions, particularly in patients with LV dysfunction. (Placement of Aortic Transcatheter Valves [PARTNER]; NCT00530894).

Copyright (c) 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: The study included patients enrolled within the PARTNER I (Placement of Aortic Transcatheter Valves) trial that underwent transfemoral (TF) or TA TAVR. Analyses of clinical outcomes were stratified by the presence of baseline LV dysfunction (LVEF<50%) and adjusted for the propensity of receiving TA TAVR.

OBJECTIVES: The authors sought to evaluate the impact of transapical (TA) transcatheter aortic valve replacement (TAVR) on mortality, left ventricular (LV) ejection fraction (LVEF) improvement, and functional recovery in patients with LV dysfunction.

RESULTS: Of 2,084 subjects, 1,057 underwent TA TAVR. TA access was associated with increased 2-year all-cause mortality in those with (adjusted hazard ratio [HR<sub>adjusted</sub>]: 1.52; 95% confidence interval [CI]: 1.12 to 2.07; p = 0.008) and without (HR<sub>adjusted</sub>: 1.38; 95% CI: 1.10 to 1.74; p = 0.006) LV dysfunction. TA TAVR portended increased 2-year cardiac mortality in subjects with LVEF<50% (HR<sub>adjusted</sub>: 1.92; 95% CI: 1.21 to 3.05; p = 0.006), but not with LVEF>=50% (HR<sub>adjusted</sub>: 1.29; 95% CI: 0.87 to 1.90; p = 0.21). In those with LVEF<50%, greater improvements in LVEF (TF-TA difference +4.04%, 95% CI: 2.39% to 5.69%; p < 0.0001) and 6-min walk distance (TF-TA difference +45.1 m, 95% CI: 18.4 to 71.9 m; p = 0.001) occurred within 30 days after TF versus TA TAVR.

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