Author + information
- Ruchir Patel,
- Elsheikh Abdelrahim,
- Mahmoud Ali,
- Nirmit Desai,
- Aditya Singh,
- Daryl Sudasena,
- Dee Dee Wang,
- Marvin H. Eng,
- William O'Neill and
- Adam Greenbaum
Background: Transcatheter aortic valve replacement (TAVR) is safe and beneficial for those with severe aortic stenosis (AS) of at least intermediate surgical risk. Despite advances in transcatheter heart valve (THV) technology, some still require urgent/emergent deployment of a second THV. The impact of acute THV-in-THV therapy on clinical outcomes has not been evaluated.
Methods: A retrospective chart review of consecutive patients who underwent TAVR from March 2012 to November 2015 at a single center was performed to compare outcomes between those with single THV therapy, elective THV-in-THV therapy and acute THV-in-THV therapy. Multivariate analysis was performed to identify predictors of all-cause mortality, cardiovascular mortality and major adverse cardiac events (MACE), defined as cardiovascular mortality, non-fatal MI, stroke and major vascular complications.
Results: 458 patients were identified and grouped by single THV therapy (n=397), those receiving acute THV-in-THV therapy (n=24), and those receiving elective valve-in-THV therapy (n=37). Overall, average age was 81 ± 18.4 years with 92% Caucasian. 51% were female with 67% within the acute THV-in-THV therapy being female. Kaplan-Meier estimates identified a statistically significant difference in all-cause mortality and cardiovascular mortality at 1 year with incidence rates of 19.2%/9.8%, 46.2%/29.2% and 8.2%/8.2% within the single THV, acute THV-in-THV and elective valve-in-THV therapy groups, respectively. Cox regression analysis identified bilirubin (HR 2.04, CI 1.10-3.80, p=0.024) hemoglobin (HR 1.45, CI 1.15-1.82, p=0.002), BUN (HR: 1.04, CI 1.02-1.06, p=0.001) and baseline ejection fraction (HR 1.04, CI 1.01-1.06, p=0.001) as independent predictors of all-cause mortality at 1 year. Cox regression analysis identified BUN (HR. 1.04, CI 1.01-1.06, p=0.005) as an independent predictor of cardiovascular mortality at 1 year.
Conclusions: Acute THV-in-THV therapy is associated with worse clinical outcomes when compared to elective valve-in-THV therapy or conventional single THV therapy and understanding of this during the post procedural management of these patients might improve outcomes.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Valvular Heart Disease: Aortic Stenosis
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1233-032
- 2017 American College of Cardiology Foundation