Comparación de la hemodinámica valvular de la prótesis transcatéter con balón expandible SAPIEN 3 frente a la autoexpandible Evolut R: estudio de casos emparejados / Comparison of the hemodynamic performance of the balloon-expandable SAPIEN 3 versus self-expandable evolut R transcatheter valve: a case-matched study

Introducción y objetivos: Las válvulas SAPIEN 3 (S3) y Medtronic Evolut R (EVR) son prótesis transcatéter de segunda generación, diseñadas para reducir el grado de insuficiencia aórtica (IAo) paravalvular. El objetivo es comparar la hemodinámica valvular en un estudio de casos emparejados con análisis ecocardiográfico independiente. Métodos: De una población de 201 pacientes tratados con implante percutáneo de válvula aórtica, se emparejó a un total de 144 (S3, n = 80; EVR, n = 64) en función del diámetro del anillo y de la puntuación de calcio aórtico medidos por tomografía computarizada. Los ecocardiogramas de seguimiento basal, al mes y a los 6 meses se analizaron de manera independiente y centralizada. Resultados: No se observaron diferencias respecto a las características basales clínicas y ecocardiográficas. La prótesis EVR mostró un mejor perfil hemodinámico evaluado mediante gradiente aórtico máximo (EVR frente a S3, 13 ± 7 frente a 20 ± 10; p < 0,001), gradiente aórtico medio (7 ± 3 frente a 11 ± 6; p < 0,001) e índice de velocidad Doppler (0,65 ± 0,15 frente a 0,51 ± 0,16; p < 0,001). Por otro lado, la tasa de IAo paravalvular moderada-grave o de cualquier grado de IAo paravalvular (≥ leve) fue mayor en el grupo de EVR (el 11 y el 50%) que en el de S3 (el 2,5 y el 21%; p < 0,05), con mayor número de chorros regurgitantes (p < 0,001). Conclusiones: En una cohorte de casos emparejados tratados con implante percutáneo de válvula aórtica de segunda generación, la S3 se asoció con una menor tasa de IAo paravalvular y mayor gradiente transprotésico residual que con la EVR

Introduction and objectives: The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis. Methods: Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed. Results: The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10 mmHg; P < .001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6 mmHg; P < .001), and Doppler velocity index (EVR 0.65 ± 0.15 vs S3 0.51 ± 0.16; P < .001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P < .05, respectively), with a larger number of paravalvular jets (P < .001). Conclusions: In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system

Long-term requirement for pacemaker implantation after cardiac valve replacement surgery.

BACKGROUND: The risk of permanent pacemaker implantation (PPI) after cardiac valve replacement surgery is thought to be highest in the postoperative period. Long-term risks are uncertain. OBJECTIVE: The purpose of this study was to determine rates and timing of PPI after cardiac valve replacement surgery. METHODS: We compared PPI rates of patients undergoing aortic valve replacement (AVR; n = 111,674), mitral valve replacement (MVR; n = 18,402), AVR + MVR (n = 5166), AVR + MVR + tricuspid valve replacement (TVR; n = 114), or coronary artery bypass surgery (CABG) without valve replacement (n = 249,742). RESULTS: Over a period of 14 years (median 3.9 years; interquartile range 1.1-7.4 years), cumulative PPI rates were 3.07-7.6 times higher (P < .001 for all) than after CABG, depending on the number of valves replaced. PPI risks after AVR were higher that those after MVR (hazard ratio [HR] 1.22; 95% confidence interval [CI] 1.16-1.28), AVR + MVR (HR 1.52; 95% CI 1.40-1.65), and AVR + MVR + TVR (HR 2.22; 95% CI 1.40-3.53), independent of known confounders. Cumulative PPI hazard rates from the postoperative period to 10 years after surgery increased after AVR (4.22%-14.4%), MVR (4.38%-15.6%), AVR + MVR (5.59%-18.3%), and AVR + MVR + TVR (7.89%-25.9%) (P < .001 for all). Age, male sex, emergency admission, and preexisting diabetes mellitus, renal impairment, and heart failure were independent predictors of PPI (P < .001 for all). CONCLUSION: Valve replacement surgery was associated with a long-term risk of PPI. This was particularly high after dual and triple valve replacements. Age, male sex, emergency admission, and preexisting diabetes mellitus, heart failure, and renal impairment were independent predictors of PPI.

Acute coronary syndrome in two patients with mechanical valve prostheses.

We report 2 similar cases of embolic myocardial infarction due to thrombus on a mechanical prosthesis despite anticoagulation therapy. In our first case, aspiration of the thrombus was performed successfully. Our second patient was given medical treatment with target international normalized ratio values between 3.5 and 4.0.

ICD-10-CA/CCI coding algorithms for defining clinical variables to assess outcome after aortic and mitral valve replacement surgery.

Implementation of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) and the Canadian Classification of Interventions (CCI) coding system presents challenges for using Canadian administrative data. Thus, a multi-step process was conducted to develop ICD-10-CA/CCI coding algorithms to define nine comorbidities and three procedures. These clinical variables have been used in ICD-9-CM data for risk adjustment in assessment of outcomes after aortic and mitral valve replacement surgery. Among patients included in the ICD-9-CM data during 1999 and 2001 and in the ICD-10-CA/CCI data during 2002 and 2003 in a Canadian Health Region, frequencies of the nine comorbidities and the three procedures remained generally similar across databases. The newly developed ICD-10-CA/CCI and previous ICD-9-CM coding algorithms are comparable in detecting these clinical variables. However, performance of ICD-10-CA/CCI coding algorithms in risk adjustment should be evaluated in a larger database.