Annals of Cardiothoracic Surgery,
Год журнала:
2024,
Номер
13(3), С. 236 - 243
Опубликована: Май 1, 2024
For
decades,
surgeons
have
recognized
the
risk
of
prosthesis-patient
mismatch
(PPM)
when
treating
aortic
stenosis
(AS)
with
surgical
valve
replacement
(SAVR).
The
concept
PPM—or
placing
a
that
is
too
small
for
cardiac
output
requirements
patient—has
been
associated
worse
patient
outcomes,
including
increased
death.
Transcatheter
(TAVR)
has
become
standard
treatment
most
patients
severe
symptomatic
AS
and
improved
hemodynamics
lower
risks
PPM.
Larger
valves,
stentless,
sutureless
technology,
annulus
enlargement
(AAE)
employed
to
avoid
However,
especially
in
(SAA),
TAVR
may
provide
benefit.
Understanding
who
at
PPM
requires
preplanning,
cardiac-gated
computed
tomography
(CT)
imaging
care
considering
TAVR.
It
should
be
all
AS.
Once
SAA
identified,
can
calculated,
an
informed
decision
made
on
whether
proceed
SAVR
or
In
current
era,
younger
are
treated
driven
by
preference,
but
little
long-term
data
support
practice.
Selecting
best
multifactorial
often
nuanced
anatomical
considerations,
hemodynamic
durability
expectations,
decisions
regarding
lifetime
management
include
second
valve.
Although
only
one
factors
consider,
association
elevated
mean
gradients
outcomes
certainly
makes
good
solution
many
patients.
European Heart Journal,
Год журнала:
2025,
Номер
unknown
Опубликована: Март 30, 2025
Although
women
with
severe
symptomatic
aortic
stenosis
have
more
complications
than
men
when
undergoing
surgical
valve
replacement,
they
are
under-represented
in
clinical
trials.
The
Randomized
researcH
womEn
all
comers
wIth
Aortic
(RHEIA)
trial
investigates
the
balance
of
benefits
and
risks
transcatheter
implantation
(TAVI)
vs.
surgery
women.
Women
were
randomized
1:1
to
transfemoral
TAVI
a
balloon-expandable
or
surgery.
primary
composite
endpoint
was
death,
stroke,
(valve,
procedure
heart
failure
related)
rehospitalization
at
1
year.
Non-inferiority
testing
pre-specified
6%
margin
superiority
performed
as-treated
population.
At
48
European
centres,
443
underwent
randomization,
420
treated
as
randomized.
Mean
age
73
years,
mean
estimated
risk
death
2.1%
(Society
Thoracic
Surgeons
score).
Kaplan-Meier
estimates
event
rates
year
8.9%
15.6%
group.
This
difference
-6.8%
an
upper
95%
confidence
limit
-1.5%
demonstrated
non-inferiority
(P
<
.001).
two-sided
interval
-13.0%
-.5%
further
resulted
=
.034).
1-year
incidence
components
was:
.9%
2.0%
for
from
any
cause,
3.3%
3.0%
5.8%
11.4%
rehospitalization.
Among
stenosis,
lower
NCT04160130.
КАРДИОЛОГИЯ УЗБЕКИСТАНА,
Год журнала:
2025,
Номер
18(4), С. 506 - 517
Опубликована: Фев. 1, 2025
Short-term
clinical
outcomes
after
transcatheter
aortic
valve
replacement
(TAVR)
are
similar
in
individuals
with
small
or
large
annuli.
The
longer
term
impact
of
prosthesis-patient
mismatch
(PPM)
and
mean
gradient
(MG)
post-TAVR
these
patients
remains
controversial.
aim
this
study
was
to
investigate
5-year
vs
Patients
from
the
PARTNER
(Placement
Aortic
Transcatheter
Valves)
2
SAPIEN
3
intermediate-risk
registry
low-risk
randomized
controlled
trial
were
grouped
according
(≤430
mm2)
(>430
annular
size.
primary
endpoint
a
composite
all-cause
death,
disabling
stroke,
heart
failure
hospitalization.
In
addition,
relationships
between
both
PPM
MG
analyzed.
total,
1,355
included:
476
annuli
(376.7
±
41.9
879
(518.3
58.0
mm2).
older
(age
79.6
7.1
years
78.7
7.8
years;
P
=
0.047),
more
often
female
(75.0%
16.2%;
<
0.0001),
had
higher
baseline
Society
Thoracic
Surgeons
scores
(4.3%
1.93%
4.0%
1.93%;
left
ventricular
ejection
fractions
(66.3%
15.82%
59.7%
13.68%;
0.0001).
Primary
rates
at
1
year
(7.8%
8.0%;
0.94)
5
(36.3%
35.8%;
0.83).
Bioprosthetic
infrequent
groups
(2.9%
2.1%;
0.46).
Among
patients,
for
(primary
endpoint;
33.6%
34.2%;
0.90).
annuli,
there
no
association
any
severity
(P
0.22)
30-day
nonlinearity
0.96).
Five-year
excellent
comparable
Outcomes
not
affected
by
PPM.
Interdisciplinary CardioVascular and Thoracic Surgery,
Год журнала:
2024,
Номер
39(1)
Опубликована: Июнь 29, 2024
Abstract
OBJECTIVES
The
healthcare
registries
in
Denmark
present
a
unique
opportunity
to
gain
novel
insights
into
the
outcomes
associated
with
both
transcatheter
and
surgical
approaches
aortic
valve
replacement.
Our
objective
is
enhance
shared
decision-making
by
comparing
long-term
mortality
clinical
between
treatments.
METHODS
This
observational
study
included
all
patients
severe
stenosis
undergoing
elective
isolated
transfemoral
implantation
(TAVI)
or
replacement
(SAVR)
Western
January
2016
April
2022.
Patient
population
data
were
identified
from
Danish
Heart
Registry
National
Registry,
respectively.
A
propensity
score-matched
was
generated.
Outcomes
investigated
according
Valve
Academic
Research
Consortium-3.
RESULTS
total
of
2269
TAVI
1094
SAVR
where
identified.
consisted
468
(mean[SD]age,
75.0[5.3]
years)
(mean[SD]
age,
75.1[4.6]years).
Kaplan–Meier
estimate
for
5-year
all-cause
29.8%
group
16.9%
(P
=
0.019).
risk
stroke
transient
ischaemic
attack
after
five
year
15.1%
11.0%
0.047).
CONCLUSIONS
underscores
importance
evaluating
patient
factors
when
choosing
an
method.
Surgical
excellent
choice,
especially
New
York
Association
class
I/II,
≥75
left
ventricular
ejection
fraction
≥50%,
longer
life
expectancy.
JACC Asia,
Год журнала:
2024,
Номер
4(12), С. 885 - 897
Опубликована: Ноя. 1, 2024
Transcatheter
aortic
valve
implantation
(TAVI)
has
been
established
as
an
effective
treatment
modality
in
patients
with
severe
stenosis
(AS)
and
the
uptake
of
TAVI
is
rapidly
growing
Asia-Pacific
region.
However,
there
exist
a
heterogeneity
management
use
among
countries
Reasons
for
these
differences
include
anatomic
variations,
disparity
healthcare
resources
infrastructure,
lack
consensus
on
optimal
AS
Hence,
Asian
Pacific
Society
Cardiology
(APSC)
working
group,
including
multidisciplinary
group
general
interventional
cardiologists,
cardiac
surgeons,
imaging
specialists,
developed
position
statement
recommendations
stenosis.
The
APSC
expert
panel
reviewed
appraised
available
evidence
using
Grading
Recommendations
Assessment,
Development,
Evaluation
system.
were
put
to
online
vote.
Consensus
was
reached
when
80%
votes
given
recommendation
support
"agree"
or
"neutral."
resulting
28
statements
provide
guidance
clinical
practitioners
region
IJC Heart & Vasculature,
Год журнала:
2024,
Номер
53, С. 101458 - 101458
Опубликована: Июль 5, 2024
Transcatheter
aortic
valve
replacement
(TAVR)
being
currently
employed
in
low
surgical
risk
patients
with
severe
symptomatic
stenosis
(AS).
The
durability
and
extended
outcomes
of
TAVR
as
compared
to
(SAVR)
low-risk
remains
uncertain.
Journal of Personalized Medicine,
Год журнала:
2024,
Номер
14(9), С. 937 - 937
Опубликована: Сен. 2, 2024
Transcatheter
aortic
valve
implantation
has
revolutionized
the
treatment
of
stenosis.
The
small
annulus
is
one
most
challenging
aspects
stenosis
and
since
beginning,
TAVI
shown
promising
results
in
this
subgroup
patients.
This
systematic
literature
review
aims
to
investigate
short
long-term
outcomes
annulus.
was
meticulously
screened
for
topic
until
April
2024
using
PRISMA
guidelines.
Technical
aspects,
characteristics
patients,
hemodynamic
performances,
are
discussed.
importance
device
selection
up,
with
insight
into
differences
between
self-expandable
balloon-expandable
valves.
Two
special
populations
were
also
taken
account:
bicuspid
extra-small
last
10
years
have
been
paramount
technological
advancements,
bringing
broader
use
population.
While
several
important
trials
underscored
usefulness
population,
clinical
practice
still
lacks
consensus
on
ideal
device,
debated.
pivotal
role
context
needs
be
addressed
a
patient-tailored
approach
optimize
patient
care.
Importance
Historically,
women
with
aortic
stenosis
have
experienced
worse
outcomes
and
inadequate
recognition
compared
to
men,
being
both
underdiagnosed
undertreated,
while
also
facing
underrepresentation
in
clinical
trials.
Objective
To
determine
whether
small
annuli
undergoing
transcatheter
valve
replacement
better
hemodynamic
a
self-expanding
(SEV)
or
balloon-expandable
(BEV).
Design,
Setting,
Participants
The
Small
Annuli
Randomized
Evolut
SAPIEN
Trial
(SMART)
was
large-scale
randomized
trial
focusing
on
patients
replacement,
receive
SEVs
BEVs
included
716
treated
at
83
centers
Canada,
Europe,
Israel,
the
US
from
April
2021
October
2022.
This
prespecified
secondary
analysis
reports
findings
for
all
621
enrolled
SMART.
Data
this
report
were
analyzed
February
2024.
Interventions
Transcatheter
an
SEV
BEV.
Main
Outcomes
Measures
composite
coprimary
end
point
comprised
death,
disabling
stroke,
heart
failure–related
rehospitalization.
function
incidence
of
bioprosthetic
dysfunction,
assessed
through
12
months.
Secondary
points
moderate
severe
prosthesis-patient
mismatch.
Results
A
total
(mean
[SD]
age,
80.2
[6.2]
years;
312
group
309
BEV
group)
present
analysis.
At
months,
there
no
significant
differences
between
groups
(9.4%
vs
11.8%,
absolute
risk
difference
−2.3%;
95%
CI
−7.2
2.5,
P
=
.35).
However,
implantation
associated
less
dysfunction
(8.4%
41.8%;
difference,
−33.4%;
CI,
−40.4
−26.4;
&lt;
.001).
resulted
lower
gradients
larger
effective
orifice
areas
30
days
months
mild
greater
regurgitation
implantation.
Prosthesis-patient
mismatch
significantly
SEVs,
regardless
definition
used
adjustment
body
mass
index.
Use
quality
life
as
by
Valve
Academic
Research
Consortium-3
ordinal
measure.
Conclusions
Relevance
Among
symptomatic
use
BEVs,
similar
markedly
reduced
including
12-month
life.
Registration
ClinicalTrials.gov
Identifier:
NCT04722250