Early Clinical Outcomes of Transcatheter Aortic Valve Replacement in Left Ventricular Outflow Tract Calcification: New-Generation Device vs Early-Generation Device.
J Invasive Cardiol
; 30(11): 421-427, 2018 11.
Article
en En
| MEDLINE
| ID: mdl-30373952
ABSTRACT
BACKGROUND:
Transcatheter aortic valve replacement (TAVR) in cases with left ventricular outflow tract calcification (LVOT-CA) remains a challenging procedure. The aim of this study was to compare the early outcomes of patients undergoing TAVR in LVOT-CA with new-generation devices vs early-generation devices.METHODS:
Between January 2014 and December 2016, a total of 433 patients with severe aortic stenosis who had a preprocedural multidetector computed tomography underwent TAVR in a LVOT-CA. After propensity matching, data from 119 patients in each group were analyzed. TAVR endpoints and adverse events were defined according to the Valve Academic Research Consortium-2.RESULTS:
Compared with early-generation devices (Edwards Sapien/Sapien XT/CoreValve), new-generation devices (Sapien 3/Evolut R) had significantly lower incidence of mild-moderate paravalvular leak (PVL) (1.7% new vs 7.6% early; P=.03), tended to have lower incidence of moderate or severe PVL (5.0% new vs 11.8% early; P=.06), had no significant difference in device success (89.1% new vs 83.2% early; P=.19), and had a significantly higher early safety rate at 30 days (93.3% new vs 84.9% early; P=.04). For cardiac conduction disturbances, new-generation and early-generation devices had similarly high rates of new permanent pacemaker implantation (16.8% new vs 15.1% early; P=.72), whereas the number of patients who developed new-onset left bundle-branch block (LBBB) were significantly higher in those with new-generation devices (16.0% new vs 6.7% early; P=.03).CONCLUSION:
In the setting of LVOT-CA, patients with new-generation devices compared to those with early-generation devices had acceptable clinical outcomes except for cardiac conduction disturbances, especially in new-onset LBBB.Palabras clave
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Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Válvula Aórtica
/
Estenosis de la Válvula Aórtica
/
Calcinosis
/
Obstrucción del Flujo Ventricular Externo
/
Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
J Invasive Cardiol
Asunto de la revista:
CARDIOLOGIA
Año:
2018
Tipo del documento:
Article