Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement: Multicenter Registry

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• 作者：Maria Del Trigo ; MD^a ; Antonio J. Muñ ; oz-Garcia ; MD^b ; Harindra C. Wijeysundera ; MD^c ; Luis Nombela-Franco ; MD^d ; Asim N. Cheema ; MD^e ; Enrique Gutierrez ; MD^f ; Vicenç ; Serra ; MD^g ; Joelle Kefer ; MD ; PhD^h ; Ignacio J. Amat-Santos ; MDⁱ ; Luis M. Benitez ; MD^j ; Jumana Mewa ; MD^c ; Pilar Jimé ; nez-Quevedo ; MD ; PhD^d ; Sami Alnasser ; MD^e ; Bruno Garcia del Blanco ; MD^g ; Antonio Dager ; MD^j ; Omar Abdul-Jawad Altisent ; MD^a ; Rishi Puri ; MBBS ; PhD^a ; Francisco Campelo-Parada ; MD^a ; Abdellaziz Dahou ; MD^a ; Jean-Michel Paradis ; MD^a ; Eric Dumont ; MD^a ; Philippe Pibarot ; DVM ; PhD^a ; Josep Rodé ; s-Cabau ; MD^a ; ^{josep.rodes@criucpq.ulaval.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：anticoagulation therapy ; transcatheter aortic valve replacement ; valve degeneration ; valve-in-valve
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：16 February 2016
• 年：2016
• 卷：67
• 期：6
• 页码：644-655
• 全文大小：702 K

文摘

Scarce data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) after transcatheter aortic valve replacement (TAVR).

Objectives

This study sought to determine the incidence, timing, and predictors of VHD in a large cohort of patients undergoing TAVR.

Methods

This multicenter registry included 1,521 patients (48% male; 80 ± 7 years of age) who underwent TAVR. Mean echocardiographic follow-up was 20 ± 13 months (minimum: 6 months). Echocardiographic examinations were performed at discharge, at 6 to 12 months, and yearly thereafter. Annualized changes in mean gradient (mm Hg/year) were calculated by dividing the difference between the mean gradient at last follow-up and the gradient at discharge by the time between examinations. VHD was defined as a ≥10 mm Hg increase in transprosthetic mean gradient during follow-up compared with discharge assessment.

Results

The overall mean annualized rate of transprosthetic gradient progression during follow-up was 0.30 ± 4.99 mm Hg/year. A total of 68 patients met criteria of VHD (incidence: 4.5% during follow-up). The absence of anticoagulation therapy at hospital discharge (p = 0.002), a valve-in-valve (TAVR in a surgical valve) procedure (p = 0.032), the use of a 23-mm valve (p = 0.016), and a greater body mass index (p = 0.001) were independent predictors of VHD.

Conclusions

There was a mild but significant increase in transvalvular gradients over time after TAVR. The lack of anticoagulation therapy, a valve-in-valve procedure, a greater body mass index, and the use of a 23-mm transcatheter valve were associated with higher rates of VHD post-TAVR. Further prospective studies are required to determine whether a specific antithrombotic therapy post-TAVR may reduce the risk of VHD.