Determinants and Outcomes of Acute Transcatheter Valve-in-Valve Therapy or Embolization A Study of Multiple Valve Implants in the US PARTNER Trial (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve)

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:62

Article

Makkar, Raj R.¹  Jilaihawi, Hasan¹  Chakravarty, Tarun¹  Fontana, Gregory P.²  Kapadia, Samir³  Babaliaros, Vasilis⁴  Cheng, Wen¹  Thourani, Vinod H.⁴  Bavaria, Joseph⁵  Svensson, Lars³  Kodali, Susheel⁶  Shiota, Takahiro¹  Siegel, Robert¹  Tuzcu, E. Murat³  Xu, Ke⁶  Hahn, Rebecca T.⁶  Herrmann, Howard C.⁵  Reisman, Mark⁷  Whisenant, Brian⁸  Lim, Scott⁹  Beohar, Nirat¹⁰  Mack, Michael¹¹  Teirstein, Paul^12,13  Rihal, Charanjit¹⁴  Douglas, Pamela S.¹⁵  Blackstone, Eugene³  Pichard, Augusto¹⁶  Webb, John G.¹⁷  Leon, Martin B.⁶ 

[1] Cedars Sinai Med Ctr, Los Angeles, CA 90048 USA

[2] Lenox Hill Heart & Vasc Inst, New York, NY USA

[3] Cleveland Clin, Cleveland, OH 44106 USA

[4] Emory Univ, Atlanta, GA 30322 USA

[5] Hosp Univ Penn, Philadelphia, PA 19104 USA

[6] Columbia Univ, Med Ctr, NY Presbyterian Hosp, New York, NY USA

[7] Swedish Med Ctr, Seattle, WA USA

[8] Intermt Med Ctr, Salt Lake City, UT USA

[9] Univ Virginia Hlth Syst, Charlottesville, VA USA

[10] Northwestern Univ, Feinberg Sch Med, Chicago, IL 60611 USA

[11] Baylor Healthcare Syst, Plano, TX USA

[12] Scripps Clin, La Jolla, CA USA

[13] Scripps Translat Sci Inst, La Jolla, CA USA

[14] Mayo Clin, Rochester, MN USA

[15] Duke Clin Res Inst, Durham, NC USA

[16] Washington Hosp Ctr, Washington, DC 20010 USA

[17] St Pauls Hosp, Vancouver, BC V6Z 1Y6, Canada

关键词: embolization;    outcomes;    TAVI;    TAVR;    transcatheter valve;    TVE;    valve-in-valve;   

DOI  :  10.1016/j.jacc.2013.04.037

来源: Elsevier

【 摘 要 】

Objectives This study investigated the determinants and outcomes of acute insertion of a second transcatheter prosthetic valve (TV) within the first (TV-in-TV) or transcatheter valve embolization (TVE) after transcatheter aortic valve replacement (TAVR). Background TAVR failure can occur with both TV-in-TV and TVE as a consequence of TAVR malpositioning. Only case reports and limited series pertaining to these complications have been reported to date. Methods Patients undergoing TAVR in the PARTNER (Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve) randomized trial (cohorts A and B) and accompanying registries were studied. Data were dichotomized for those with and without TV-in-TV or TVE, respectively. Results From a total of 2,554 consecutive patients, 63 (2.47%) underwent TV-in-TV and 26 (1.01%) TVE. The indication for TV-in-TV was significant aortic regurgitation in most patients, often due not only to malpositioning but also to leaflet dysfunction. Despite similar aortic valve function on follow-up echoes, TV-in-TV was an independent predictor of 1-year cardiovascular mortality (hazard ratio [HR]: 1.86, 95% confidence interval [CI]: 1.03 to 3.38, p = 0.041), with a nonsignificant trend toward greater all-cause mortality (HR: 1.43, 95% CI: 0.88 to 2.33, p = 0.15). Technical and anatomical reasons accounted for most cases of TVE. A multivariable analysis found TVE to be an independent predictor of 1-year mortality (HR: 2.68, 95% CI: 1.34 to 5.36, p = 0.0055) but not cardiovascular mortality (HR: 1.30, 95% CI: 0.48 to 3.52, p = 0.60). Conclusions Acute TV-in-TV and TVE are serious sequelae of TAVR, often resulting in multiple valve implants. They carry an excess of mortality and are caused by anatomic and technical factors, which may be avoidable with judicious procedural planning. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894) (C) 2013 by the American College of Cardiology Foundation

【 授权许可】

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