Doppler Velocity Index Outcomes Following Surgical or Transcatheter Aortic Valve Replacement in the PARTNER Trials.

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Citation: Jacc: Cardiovascular Interventions. 14(14):1594-1606, 2021 07 26.PMID: 34217631Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Aortic Valve Stenosis | *Heart Valve Prosthesis | *Heart Valve Prosthesis Implantation | *Transcatheter Aortic Valve Replacement | Aortic Valve Stenosis/dg [Diagnostic Imaging] | Aortic Valve Stenosis/su [Surgery] | Aortic Valve/dg [Diagnostic Imaging] | Aortic Valve/su [Surgery] | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | Humans | Risk Factors | Severity of Illness Index | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment OutcomeYear: 2021Local holdings: Available online through MWHC library: 2008 - presentName of journal: JACC. Cardiovascular interventionsAbstract: BACKGROUND: DVI >0.35 is normal for a prosthetic valve, but recent studies suggest that DVI <0.50 is associated with poor outcomes following TAVR.CONCLUSIONS: In intermediate- and low-risk cohorts of the PARTNER trials, DVI <=0.35 predicted worse 2-year outcomes following SAVR, driven primarily by rehospitalization, with no adverse outcomes associated with DVI following TAVR with the balloon-expandable SAPIEN 3 valve. Copyright (c) 2021. Published by Elsevier Inc.METHODS: Patients with severe aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valve) 2 (intermediate surgical risk) or PARTNER 3 (low surgical risk) trial undergoing TAVR (n = 1,450) or SAVR (n = 1,303) were included. Patients were divided into 3 DVI groups on the basis of core laboratory-assessed discharge or 30-day echocardiograms: DVILOW (<=0.35), DVIINTERMEDIATE (>0.35 to <=0.50), and DVIHIGH (>0.50). Two-year outcomes were assessed.OBJECTIVES: The aim of this study was to assess the association between Doppler velocity index (DVI) and 2-year outcomes for balloon-expandable SAPIEN 3 transcatheter aortic valve replacement (TAVR) and for surgical aortic valve replacement (SAVR).RESULTS: Following TAVR, there were no differences among the 3 DVI groups in composite outcomes of death, stroke, or rehospitalization or in any individual components of 2-year outcomes (P > 0.70 for all). Following SAVR, there was no difference among DVI groups in the composite outcome (P = 0.27), but there was a significant association with rehospitalization (P = 0.02). Restricted cubic-spline analysis for combined outcomes showed an increased risk with post-SAVR DVI <=0.35 but no relationship post-TAVR. DVI <=0.35 was associated with increased 2-year composite outcome for SAVR (HR: 1.81; 95% CI: 1.29-2.54; P < 0.001), with no adverse outcomes for TAVR (P = 0.86).All authors: Blanke P, Chen Y, Clavel MA, Douglas PS, Hahn RT, Jaber WA, Kapadia S, Khalique OK, Kodali S, Leipsic J, Leon MB, Mack MJ, Makkar R, Pibarot P, Smith CR, Thourani VH, Weissman NJOriginally published: Jacc: Cardiovascular Interventions. 2021 Jun 23Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-07-26
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Journal Article MedStar Authors Catalog Article 34217631 Available 34217631

Available online through MWHC library: 2008 - present

BACKGROUND: DVI >0.35 is normal for a prosthetic valve, but recent studies suggest that DVI <0.50 is associated with poor outcomes following TAVR.

CONCLUSIONS: In intermediate- and low-risk cohorts of the PARTNER trials, DVI <=0.35 predicted worse 2-year outcomes following SAVR, driven primarily by rehospitalization, with no adverse outcomes associated with DVI following TAVR with the balloon-expandable SAPIEN 3 valve. Copyright (c) 2021. Published by Elsevier Inc.

METHODS: Patients with severe aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valve) 2 (intermediate surgical risk) or PARTNER 3 (low surgical risk) trial undergoing TAVR (n = 1,450) or SAVR (n = 1,303) were included. Patients were divided into 3 DVI groups on the basis of core laboratory-assessed discharge or 30-day echocardiograms: DVILOW (<=0.35), DVIINTERMEDIATE (>0.35 to <=0.50), and DVIHIGH (>0.50). Two-year outcomes were assessed.

OBJECTIVES: The aim of this study was to assess the association between Doppler velocity index (DVI) and 2-year outcomes for balloon-expandable SAPIEN 3 transcatheter aortic valve replacement (TAVR) and for surgical aortic valve replacement (SAVR).

RESULTS: Following TAVR, there were no differences among the 3 DVI groups in composite outcomes of death, stroke, or rehospitalization or in any individual components of 2-year outcomes (P > 0.70 for all). Following SAVR, there was no difference among DVI groups in the composite outcome (P = 0.27), but there was a significant association with rehospitalization (P = 0.02). Restricted cubic-spline analysis for combined outcomes showed an increased risk with post-SAVR DVI <=0.35 but no relationship post-TAVR. DVI <=0.35 was associated with increased 2-year composite outcome for SAVR (HR: 1.81; 95% CI: 1.29-2.54; P < 0.001), with no adverse outcomes for TAVR (P = 0.86).

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