Outcomes 2 Years After Transcatheter Aortic Valve Replacement in Patients at Low Surgical Risk

Journal of the American College of Cardiology, Journal Year: 2021, Volume and Issue: 77(9), P. 1149 - 1161

Published: March 1, 2021

Language: Английский

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Transcatheter Aortic-Valve Replacement in Low-Risk Patients at Five Years

New England Journal of Medicine, Journal Year: 2023, Volume and Issue: 389(21), P. 1949 - 1960

Published: Oct. 24, 2023

A previous analysis in this trial showed that among patients with severe, symptomatic aortic stenosis who were at low surgical risk, the rate of composite end point death, stroke, or rehospitalization 1 year was significantly lower transcatheter aortic-valve replacement (TAVR) than replacement. Longer-term outcomes are unknown.

Language: Английский

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Transcatheter treatment for tricuspid valve disease

EuroIntervention, Journal Year: 2021, Volume and Issue: 17(10), P. 791 - 808

Published: Nov. 1, 2021

Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality the valve apparatus and is observed in only 8-10% patients with disease. Secondary common arises as a result annular dilation caused by right ventricular enlargement dysfunction consequence pulmonary hypertension, often left-sided heart disease atrial fibrillation. Irrespective its aetiology, leads to volume overload increased wall stress, both which negatively contribute detrimental remodelling worsening TR. This vicious circle translates into impaired survival failure symptoms without reduced left ejection fraction. Interventions correct are underutilised daily clinical practice owing surgical risk late patient presentation. The recently introduced transcatheter interventions aim address this unmet need. Dedicated expertise an interdisciplinary Heart Team evaluation essential integrate these new techniques successfully select patients. present article proposes standardised approach evaluate who may be candidates for interventions. In addition, state-of-the-art review available therapies, main criteria device selection, information concerning remaining uncertainties provided.

Language: Английский

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EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ

European Journal of Cardio-Thoracic Surgery, Journal Year: 2023, Volume and Issue: 65(2)

Published: Dec. 20, 2023

A clinical guideline aims to apply all patients with a specific condition.However, there will inevitably be situations where its recommendations aren't suitable for particular patient.While healthcare professionals and others are encouraged consider these guidelines in their professional judgement, they don't override the responsibility of make decisions tailored each patient's unique circumstances.Such should aligned latest official recommendations, from relevant public health authorities, applicable rules regulations.It is important that made collaboration with, agreed upon by, patient and/or guardian or carer.

Language: Английский

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3-Year Outcomes After Transcatheter or Surgical Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 81(17), P. 1663 - 1674

Published: March 5, 2023

Randomized data comparing outcomes of transcatheter aortic valve replacement (TAVR) with surgery in low–surgical risk patients at time points beyond 2 years is limited. This presents an unknown for physicians striving to educate as part a shared decision-making process. The authors evaluated 3-year clinical and echocardiographic from the Evolut Low Risk trial. Low-risk were randomized TAVR self-expanding, supra-annular or surgery. primary endpoint all-cause mortality disabling stroke several secondary endpoints assessed 3 years. There 1,414 attempted implantations (730 TAVR; 684 surgery). Patients had mean age 74 35% women. At years, occurred 7.4% 10.4% (HR: 0.70; 95% CI: 0.49-1.00; P = 0.051). difference between treatment arms remained broadly consistent over time: −1.8% year 1; −2.0% 2; −2.9% 3. incidence mild paravalvular regurgitation (20.3% vs 2.5% surgery) pacemaker placement (23.2% 9.1% surgery; < 0.001) lower group. Rates moderate greater both groups <1% not significantly different. who underwent improved hemodynamics (mean gradient 9.1 mm Hg 12.1 Within study, showed durable benefits compared respect stroke. (Medtronic Transcatheter Aortic Valve Replacement Patients; NCT02701283)

Language: Английский

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Deformation of Transcatheter Aortic Valve Prostheses: Implications for Hypoattenuating Leaflet Thickening and Clinical Outcomes

Circulation, Journal Year: 2022, Volume and Issue: 146(6), P. 480 - 493

Published: Aug. 8, 2022

Although transcatheter aortic valve replacement (TAVR) therapy continues to grow, there have been concerns about the occurrence of hypoattenuating leaflet thickening (HALT), which may affect prosthesis function or durability. This study aimed examine frame factors and correlate their extent frequency HALT clinical outcomes.We prospectively examined 565 patients with cardiac computed tomography screening for at 30 days after balloon-expandable SAPIEN3 self-expanding EVOLUT TAVR. Deformation TAVR prostheses, asymmetric expansion, sinus volumes, commissural alignment were analyzed on postprocedural tomography. For descriptive purposes, an index deformation was calculated, values >1.00 representing relative midsegment underexpansion. A time-to-event model performed evaluate association outcome.Overall, present in 21% 16% The directly associated greater (P<0.001), worse asymmetry leaflets smaller neosinus volumes (P<0.001). These relations both prosthetic types all size ranges (all P<0.05). In multivariable analyses that include variables previously (eg, anticoagulant therapy), remained predictive HALT. not changes hemodynamics, its presence risk mortality 1 year, respect incidences all-cause (hazard ratio, 2.98 [95% CI, 1.57-5.63]; P=0.001), death 4.58 1.81-11.6]; a composite outcome heart failure hospitalization 1.94 1.14-3.30]; P=0.02) adjustment age, sex, comorbidities.Nonuniform expansion prostheses resulting deformation, leaflet, volume is related who undergo data implications design deployment techniques improve outcomes these patients.

Language: Английский

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Self-Expanding or Balloon-Expandable TAVR in Patients with a Small Aortic Annulus

New England Journal of Medicine, Journal Year: 2024, Volume and Issue: 390(21), P. 1959 - 1971

Published: April 7, 2024

Patients with severe aortic stenosis and a small annulus are at risk for impaired valvular hemodynamic performance associated adverse cardiovascular clinical outcomes after transcatheter aortic-valve replacement (TAVR).

Language: Английский

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Tricuspid Valve Academic Research Consortium Definitions for Tricuspid Regurgitation and Trial Endpoints

Journal of the American College of Cardiology, Journal Year: 2023, Volume and Issue: 82(17), P. 1711 - 1735

Published: Oct. 1, 2023

Interest in the pathophysiology, etiology, management, and outcomes of patients with tricuspid regurgitation (TR) has grown wake multiple natural history studies showing progressively worse associated increasing TR severity, even after adjusting for comorbidities. Historically, isolated valve surgery been high in-hospital mortality rates, leading to development transcatheter treatment options. The aim this first Tricuspid Valve Academic Research Consortium document is standardize definitions disease etiology as well endpoints trials that address gaps our knowledge related identification management TR. Standardizing should provide consistency enable meaningful comparisons between clinical trials. A second will focus on further defining trial discuss design

Language: Английский

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2-Year Outcomes After Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients

Journal of the American College of Cardiology, Journal Year: 2022, Volume and Issue: 79(9), P. 882 - 896

Published: Feb. 28, 2022

Language: Английский

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EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ

The Annals of Thoracic Surgery, Journal Year: 2024, Volume and Issue: 118(1), P. 5 - 115

Published: Feb. 26, 2024

Language: Английский

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