Author + information
- Saif Anwaruddin1,
- Nimesh Desai2,
- Michael J. Reardon3,
- James B. Hermiller Jr.4,
- Paul Sorajja5,
- Susheel Kodali6,
- Jeffrey J. Popma7,
- Jay Giri8,
- Howard Herrmann1,
- Gilbert Tang9,
- Fenton McCarthy1 and
- Wilson Y. Szeto1
- 1University of Pennsylvania, Philadelphia, Pennsylvania, United States
- 2University of Pennsylvannia, Philadelphia, Pennsylvania, United States
- 3Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas, United States
- 4St. Vincent Hospital/The Heart Center of Indiana, Indianapolis, Indiana, United States
- 5Minneapolis Heart Institute, Minneapolis, Minnesota, United States
- 6New York Presbyterian Hospital-Columbia University Medical Center, New York, New York, United States
- 7Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 8University of Pennsylavnia, Philadelphia, Pennsylvania, United States
- 9Mount Sinai Health System, New York, New York, United States
Transcatheter aortic valve replacement (TAVR) is approved for treatment of symptomatic severe aortic stenosis (AS). However, outcomes of high/extreme-risk patients with severe aortic insufficiency (AI) treated with TAVR off-label are unknown.
From Jan 2014 to Sept 2016, outcomes of patients in the STS/ACC TVT Registry who underwent TAVR for primary severe AI were compared with those for severe AS using a commercially available self-expanding valve system. Patients with failed prior surgical or transcatheter valves were excluded. AI was defined as primary, or mixed with predominantly moderate/severe AI and a mean aortic valve gradient ≤20. AS was defined as primary AS, with AVA ≤ 0.8 cm2 or AVAi ≤ 0.5cm2.
125 pts underwent TAVR for AI and 15,932 patients for AS. Those with AI were younger (69.3±14.2 vs 81.1±7.9, p<0.001) and had lower left ventricular ejection fraction (42.0±17.7 vs 53.3±14.6, p<0.001). Fewer in the AI group had diabetes mellitus (21.0% vs. 38.1%, p<0.001), coronary artery disease (45.6% vs 68.2%, p<0.001), and more had renal insufficiency (14.5% vs. 8.9%, p=0.028). The STS-PROM score was similar (8.7±8.6% vs 8.1±5.3%, p=0.51). Pts with AI more often required >1 valve (27.2% vs 4.1%, p<0.001), and more often a larger 31mm valve (39.6% vs 24.7%, p<0.001). Unadjusted length of hospital stay (days) (Median [IQR] 7.0 [3.0,14.0] vs 4.0 [3.0,8.0], p<0.001), in-hospital all-cause mortality (15.2% vs 2.9%, p<0.001), and Kaplan-Meier (KM) 30-day all-cause mortality (15.5% vs 4.3%, p<0.001) were higher in patients with AI. KM 30-day all-cause mortality was 18.2% when CoreValve system was used to treat AI vs 10.9% for Evolut R system. Higher device migration rate (7.2% vs 0.4%, p<0.001) was noted in pts treated for AI compared to AS. The rate of moderate/severe paravalvular regurgitation was 14.9% with AI group vs 8.4% with AS.
Important clinical differences were identified when comparing patients undergoing TAVR with a self-expanding prosthesis for primary AI vs AS. Unadjusted in-hospital and 30-day outcomes were worse when treating AI. Future research is warranted to identify the association of independent factors with outcomes in AI patients treated with TAVR.
STRUCTURAL: Valvular Disease: Aortic