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Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry

Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of...

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Autores principales: Deharo, Pierre, Leroux, Lionel, Theron, Alexis, Ferrara, Jérome, Vaillier, Antoine, Jaussaud, Nicolas, Porto, Alizée, Morera, Pierre, Gariboldi, Vlad, Iung, Bernard, Lefevre, Thierry, Commeau, Philippe, Gouysse, Margaux, du Chayla, Florence, Glatt, Nicolas, Cayla, Guillaume, Le Breton, Herve, Benamer, Hakim, Beurtheret, Sylvain, Verhoye, Jean Philippe, Eltchaninoff, Helene, Gilard, Martine, Collet, Jean Philippe, Dumonteil, Nicolas, Collart, Frederic, Modine, Thomas, Cuisset, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604905/
https://www.ncbi.nlm.nih.gov/pubmed/36294438
http://dx.doi.org/10.3390/jcm11206117
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author Deharo, Pierre
Leroux, Lionel
Theron, Alexis
Ferrara, Jérome
Vaillier, Antoine
Jaussaud, Nicolas
Porto, Alizée
Morera, Pierre
Gariboldi, Vlad
Iung, Bernard
Lefevre, Thierry
Commeau, Philippe
Gouysse, Margaux
du Chayla, Florence
Glatt, Nicolas
Cayla, Guillaume
Le Breton, Herve
Benamer, Hakim
Beurtheret, Sylvain
Verhoye, Jean Philippe
Eltchaninoff, Helene
Gilard, Martine
Collet, Jean Philippe
Dumonteil, Nicolas
Collart, Frederic
Modine, Thomas
Cuisset, Thomas
author_facet Deharo, Pierre
Leroux, Lionel
Theron, Alexis
Ferrara, Jérome
Vaillier, Antoine
Jaussaud, Nicolas
Porto, Alizée
Morera, Pierre
Gariboldi, Vlad
Iung, Bernard
Lefevre, Thierry
Commeau, Philippe
Gouysse, Margaux
du Chayla, Florence
Glatt, Nicolas
Cayla, Guillaume
Le Breton, Herve
Benamer, Hakim
Beurtheret, Sylvain
Verhoye, Jean Philippe
Eltchaninoff, Helene
Gilard, Martine
Collet, Jean Philippe
Dumonteil, Nicolas
Collart, Frederic
Modine, Thomas
Cuisset, Thomas
author_sort Deharo, Pierre
collection PubMed
description Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up.
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spelling pubmed-96049052022-10-27 Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry Deharo, Pierre Leroux, Lionel Theron, Alexis Ferrara, Jérome Vaillier, Antoine Jaussaud, Nicolas Porto, Alizée Morera, Pierre Gariboldi, Vlad Iung, Bernard Lefevre, Thierry Commeau, Philippe Gouysse, Margaux du Chayla, Florence Glatt, Nicolas Cayla, Guillaume Le Breton, Herve Benamer, Hakim Beurtheret, Sylvain Verhoye, Jean Philippe Eltchaninoff, Helene Gilard, Martine Collet, Jean Philippe Dumonteil, Nicolas Collart, Frederic Modine, Thomas Cuisset, Thomas J Clin Med Article Background: Transcatheter aortic valve implantation (TAVI) is the preferred treatment for symptomatic severe aortic stenosis (AS) in a majority of patients across all surgical risks. Patients and methods: Paravalvular leak (PVL) and patient–prosthesis mismatch (PPM) are two frequent complications of TAVI. Therefore, based on the large France-TAVI registry, we planned to report the incidence of both complications following TAVI, evaluate their respective risk factors, and study their respective impacts on long-term clinical outcomes, including mortality. Results: We identified 47,494 patients in the database who underwent a TAVI in France between 1 January 2010 and 31 December 2019. Within this population, 17,742 patients had information regarding PPM status (5138 with moderate-to-severe PPM, 29.0%) and 20,878 had information regarding PVL (4056 with PVL ≥ 2, 19.4%). After adjustment, the risk factors for PVL ≥ 2 were a lower body mass index (BMI), a high baseline mean aortic gradient, a higher body surface area, a lower ejection fraction, a smaller diameter of TAVI, and a self-expandable TAVI device, while for moderate-to-severe PPM we identified a younger age, a lower BMI, a larger body surface area, a low aortic annulus area, a low ejection fraction, and a smaller diameter TAVI device (OR 0.85; 95% CI, 0.83–0.86) as predictors. At 6.5 years, PVL ≥ 2 was an independent predictor of mortality and was associated with higher mortality risk. PPM was not associated with increased risk of mortality. Conclusions: Our analysis from the France-TAVI registry showed that both moderate-to-severe PPM and PVL ≥ 2 continue to be frequently observed after the TAVI procedure. Different risk factors, mostly related to the patient’s anatomy and TAVI device selection, for both complications have been identified. Only PVL ≥ 2 was associated with higher mortality during follow-up. MDPI 2022-10-17 /pmc/articles/PMC9604905/ /pubmed/36294438 http://dx.doi.org/10.3390/jcm11206117 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Deharo, Pierre
Leroux, Lionel
Theron, Alexis
Ferrara, Jérome
Vaillier, Antoine
Jaussaud, Nicolas
Porto, Alizée
Morera, Pierre
Gariboldi, Vlad
Iung, Bernard
Lefevre, Thierry
Commeau, Philippe
Gouysse, Margaux
du Chayla, Florence
Glatt, Nicolas
Cayla, Guillaume
Le Breton, Herve
Benamer, Hakim
Beurtheret, Sylvain
Verhoye, Jean Philippe
Eltchaninoff, Helene
Gilard, Martine
Collet, Jean Philippe
Dumonteil, Nicolas
Collart, Frederic
Modine, Thomas
Cuisset, Thomas
Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title_full Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title_fullStr Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title_full_unstemmed Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title_short Long-Term Prognosis Value of Paravalvular Leak and Patient–Prosthesis Mismatch following Transcatheter Aortic Valve Implantation: Insight from the France-TAVI Registry
title_sort long-term prognosis value of paravalvular leak and patient–prosthesis mismatch following transcatheter aortic valve implantation: insight from the france-tavi registry
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9604905/
https://www.ncbi.nlm.nih.gov/pubmed/36294438
http://dx.doi.org/10.3390/jcm11206117
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