Direct Transcatheter Heart Valve Implantation Versus Implantation With Balloon Predilatation

Author:

Bernardi Fernando L.M.1,Ribeiro Henrique B.1,Carvalho Luiz A.1,Sarmento-Leite Rogerio1,Mangione José A.1,Lemos Pedro A.1,Abizaid Alexandre1,Grube Eberhard1,Rodés-Cabau Josep1,de Brito Fábio S.1

Affiliation:

1. From the Department of Interventional Cardiology, Heart Institute-InCor, University of São Paulo, Brazil (F.L.M.B., H.B.R., P.A.L.); Department of Interventional Cardiology, TotalCor Hospital, Sao Paulo, Brazil (H.B.R.); Department of Interventional Cardiology, Hospital Pro-Cardiaco, Rio de Janeiro, Brazil (L.A.C.); Department of Interventional Cardiology, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil (R.S.-L.); Department of Interventional Cardiology, Hospital Beneficencia...

Abstract

Background— Direct transcatheter aortic valve replacement (TAVR) is regarded as having potential advantages over TAVR with balloon aortic valve predilatation (BAVP) in reducing procedural complications, but there are few data to support this approach. Methods and Results— Patients included in the Brazilian TAVR registry with CoreValve and Sapien-XT prosthesis were compared according to the implantation technique, with or without BAVP. Clinical and echocardiographic data were analyzed in overall population and after propensity score matching. A total of 761 consecutive patients (BAVP=372; direct-TAVR=389) were included. Direct-TAVR was possible in 99% of patients, whereas device success was similar between groups (BAVP=81.2% versus direct-TAVR=78.1%; P =0.3). No differences in clinical outcomes at 30 days and 1 year were observed, including all-cause mortality (7.6% versus 10%; P =0.25 and 18.1% versus 24.5%; P =0.07, respectively) and stroke (2.8% versus 3.8%; P =0.85 and 5.5% versus 6.8%; P =0.56, respectively). Nonetheless, TAVR with BAVP was associated with a higher rate of new onset persistent left bundle branch block with the CoreValve (47.7% versus 35.1%; P =0.01 at 1 year). Mean gradient and incidence of moderate/severe aortic regurgitation were similar in both groups at 1 year (11% versus 13.3%; P =0.57 and 9.8±5.5 versus 8.7±4.3; P =0.09, respectively). After propensity score matching analysis, all-cause mortality and stroke remained similar. By multivariable analysis, BAVP and the use of CoreValve were independent predictors of new onset persistent left bundle branch block. Conclusions— The 2 TAVR strategies, with or without BAVP, provided similar clinical and echocardiographic outcomes over a midterm follow-up although BAVP was associated with a higher rate of new onset persistent left bundle branch block, particularly in patients receiving a CoreValve.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Cardiology and Cardiovascular Medicine

Cited by 36 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3