MedStar Authors catalog › Details for: Durability and Clinical Outcomes of Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses.
Durability and Clinical Outcomes of Transcatheter Aortic Valve Replacement for Failed Surgical Bioprostheses. Journal: Circulation. Cardiovascular interventions.Published: ; 2019; ISSN: 1941-7640.UI/PMID: 31607151.Subject(s): Aged | Treatment Outcome | Transcatheter Aortic Valve Replacement/mo [Mortality] | *Transcatheter Aortic Valve Replacement/is [Instrumentation] | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Time Factors | Risk Factors | Recovery of Function | Quality of Life | *Prosthesis Failure | Prosthesis Design | Prospective Studies | Middle Aged | Male | Humans | Hemodynamics | Heart Valve Prosthesis Implantation/mo [Mortality] | *Heart Valve Prosthesis Implantation/is [Instrumentation] | Heart Valve Prosthesis Implantation/ae [Adverse Effects] | *Heart Valve Prosthesis | Female | Bioprosthesis | *Aortic Valve Stenosis/su [Surgery] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve Stenosis/mo [Mortality] | Aortic Valve Stenosis/dg [Diagnostic Imaging] | *Aortic Valve/su [Surgery] | Aortic Valve/pp [Physiopathology] | Aortic Valve/dg [Diagnostic Imaging] | Aged, 80 and overInstitution(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/10.1161/CIRCINTERVENTIONS.119.008155 (Click here) Abbreviated citation: ; Circ., Cardiovasc. interv.. 12(10):e008155, 2019 10.Local Holdings: Available online from MWHC library: 2008 - present.Abstract: BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (TAVR) is an option when a surgical valve demonstrates deterioration and dysfunction. This study reports 3-year results following valve-in-valve with self-expanding TAVR.Abstract: CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01675440.Abstract: CONCLUSIONS: Self-expanding TAVR in patients with failed surgical bioprostheses at extreme risk for surgery was associated with durable hemodynamics and excellent clinical outcomes. Preexisting surgical valve prosthesis-patient mismatch was not associated with mortality but did limit patient improvement in quality of life over 3-year follow-up.Abstract: METHODS: The CoreValve US Expanded Use Study is a prospective, nonrandomized, single-arm study that evaluates safety and effectiveness of TAVR in extreme risk patients with symptomatic failed surgical biologic aortic valves. Study end points include all-cause mortality, need for valve reintervention, hemodynamic changes over time, and quality of life through 3 years. Patients were stratified by presence of preexisting surgical valve prosthesis-patient mismatch.Abstract: RESULTS: From March 2013 to May 2015, 226 patients deemed extreme risk (STS-PROM [Society of Thoracic Surgeons Predicted Risk of Mortality] 9.0+/-7%) had attempted valve-in-valve TAVR. Preexisting surgical valve prosthesis-patient mismatch was present in 47.2% of the cohort. At 3 years, all-cause mortality or major stroke was 28.6%, and 93% of patients were in New York Heart Association I or II heart failure. Valve performance was maintained over 3 years with low valve reintervention rates (4.4%), an improvement in effective orifice area over time and a 2.7% rate of severe structural valve deterioration. Preexisting severe prosthesis-patient mismatch was not associated with 3-year mortality but was associated with significantly less improvement in quality of life at 3-year follow-up (P=0.01).