TY  - BOOK
AU  - Thourani, Vinod H
TI  - Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial
SN  - 1936-8798
PY  - 2017///
KW  - *Aortic Valve Stenosis/su [Surgery]
KW  - *Aortic Valve/su [Surgery]
KW  - *Transcatheter Aortic Valve Replacement/mo [Mortality]
KW  - *Ventricular Dysfunction, Left/pp [Physiopathology]
KW  - *Ventricular Function, Left
KW  - Aged
KW  - Aged, 80 and over
KW  - Aortic Valve Stenosis/dg [Diagnostic Imaging]
KW  - Aortic Valve Stenosis/mo [Mortality]
KW  - Aortic Valve Stenosis/pp [Physiopathology]
KW  - Aortic Valve/dg [Diagnostic Imaging]
KW  - Aortic Valve/pp [Physiopathology]
KW  - Chi-Square Distribution
KW  - Clinical Decision-Making
KW  - Echocardiography
KW  - Female
KW  - Humans
KW  - Kaplan-Meier Estimate
KW  - Linear Models
KW  - Male
KW  - Propensity Score
KW  - Proportional Hazards Models
KW  - Recovery of Function
KW  - Registries
KW  - Risk Assessment
KW  - Risk Factors
KW  - Severity of Illness Index
KW  - Stroke Volume
KW  - Time Factors
KW  - Transcatheter Aortic Valve Replacement/ae [Adverse Effects]
KW  - Transcatheter Aortic Valve Replacement/mt [Methods]
KW  - Treatment Outcome
KW  - Ventricular Dysfunction, Left/dg [Diagnostic Imaging]
KW  - Ventricular Dysfunction, Left/mo [Mortality]
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online through MWHC library: 2008 - present
N2  - 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
UR  - https://dx.doi.org/10.1016/j.jcin.2017.09.023
ER  -