Transcatheter Aortic Valve Replacement Beyond Severe Aortic Stenosis

Journal of the American College of Cardiology, Год журнала: 2025, Номер 85(9), С. 944 - 964

Опубликована: Март 1, 2025

Язык: Английский

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Transcatheter vs. surgical aortic valve replacement in women: the RHEIA trial

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.

Язык: Английский

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Late Clinical Outcomes of Balloon-Expandable Valves in Small Annuli

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.

Язык: Английский

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Severe aortic stenosis treated with transcatheter aortic valve implantation or surgical aortic valve replacement with Perimount in Western Denmark 2016–2022: a nationwide retrospective study

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.

Язык: Английский

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Asian Pacific Society of Cardiology Position Statement on the Use of Transcatheter Aortic Valve Implantation in the Management of Aortic Stenosis

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

Язык: Английский

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Efficacy and safety of TAVR versus SAVR in patients with small aortic annuli: A systematic review and meta-analysis

International Journal of Cardiology, Год журнала: 2024, Номер 411, С. 132243 - 132243

Опубликована: Июнь 6, 2024

Язык: Английский

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Short- and intermediate-term outcomes of transcatheter aortic valve replacement in low-risk patients: A meta-analysis and systematic review

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.

Язык: Английский

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Impact of Small Aortic Annuli on the Performance of Transcatheter Aortic Valve Replacement Bioprostheses: An Updated Meta-analysis of Recent Studies

The American Journal of Cardiology, Год журнала: 2024, Номер 229, С. 1 - 12

Опубликована: Июль 23, 2024

Язык: Английский

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Short and Long-Term Outcomes of Transcatheter Aortic Valve Implantation in the Small Aortic Annulus: A Systematic Literature Review

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.

Язык: Английский

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Transcatheter Aortic Valve Implantation by Valve Type in Women With Small Annuli

JAMA Cardiology, Год журнала: 2024, Номер unknown

Опубликована: Окт. 9, 2024

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; &amp;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

Язык: Английский

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