Cargando…

Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency

Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replace...

Descripción completa

Detalles Bibliográficos
Autores principales: Rali, Aniket S, Taduru, Siva S, Tran, Lena E, Ranka, Sagar, Schlendorf, Kelly H, Barker, Colin M, Shah, Ashish S, Lindenfeld, JoAnn, Zalawadiya, Sandip K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Radcliffe Cardiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819997/
https://www.ncbi.nlm.nih.gov/pubmed/36644645
http://dx.doi.org/10.15420/cfr.2022.21
_version_ 1784865364103921664
author Rali, Aniket S
Taduru, Siva S
Tran, Lena E
Ranka, Sagar
Schlendorf, Kelly H
Barker, Colin M
Shah, Ashish S
Lindenfeld, JoAnn
Zalawadiya, Sandip K
author_facet Rali, Aniket S
Taduru, Siva S
Tran, Lena E
Ranka, Sagar
Schlendorf, Kelly H
Barker, Colin M
Shah, Ashish S
Lindenfeld, JoAnn
Zalawadiya, Sandip K
author_sort Rali, Aniket S
collection PubMed
description Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06–0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR.
format Online
Article
Text
id pubmed-9819997
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Radcliffe Cardiology
record_format MEDLINE/PubMed
spelling pubmed-98199972023-01-12 Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency Rali, Aniket S Taduru, Siva S Tran, Lena E Ranka, Sagar Schlendorf, Kelly H Barker, Colin M Shah, Ashish S Lindenfeld, JoAnn Zalawadiya, Sandip K Card Fail Rev Treatment Background: Worsening aortic insufficiency (AI) is a known sequela of prolonged continuous-flow left ventricular assist device (LVAD) support with a significant impact on patient outcomes. While medical treatment may relieve symptoms, it is unlikely to halt progression. Surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are among non-medical interventions available to address post-LVAD AI. Limited data are available on outcomes with either SAVR or TAVR for the management of post-LVAD AI. Methods: The National Inpatient Sample data collected for hospital admissions between the years 2015 and 2018 for patients with pre-existing continuous-flow LVAD undergoing TAVR or SAVR for AI were queried. The primary outcome of interest was a composite of in-hospital mortality, stroke, transient ischaemic attack, MI, pacemaker implantation, need for open aortic valve surgery, vascular complications and cardiac tamponade. Results: Patients undergoing TAVR were more likely to receive their procedure during an elective admission (57.1 versus 30%, p=0.002), and a significantly higher prevalence of comorbidities, as assessed by the Elixhauser Comorbidity Index, was observed in the SAVR group (29 versus 18; p=0.0001). We observed a significantly higher prevalence of the primary composite outcome in patients undergoing SAVR (30%) compared with TAVR (14.3%; p=0.001). Upon multivariable analysis adjusting for the type of admission and Elixhauser Comorbidity Index, TAVR was associated with significantly lower odds of the composite outcome (odds ratio 0.243; 95% CI [0.06–0.97]; p=0.045). Conclusion: In this nationally representative cohort of LVAD patients with post-implant AI, it was observed that TAVR was associated with a lower risk of adverse short-term outcomes compared with SAVR. Radcliffe Cardiology 2022-10-07 /pmc/articles/PMC9819997/ /pubmed/36644645 http://dx.doi.org/10.15420/cfr.2022.21 Text en Copyright © 2022, Radcliffe Cardiology https://creativecommons.org/licenses/by-nc/4.0/This work is open access under the CC-BY-NC 4.0 License which allows users to copy, redistribute and make derivative works for non-commercial purposes, provided the original work is cited correctly.
spellingShingle Treatment
Rali, Aniket S
Taduru, Siva S
Tran, Lena E
Ranka, Sagar
Schlendorf, Kelly H
Barker, Colin M
Shah, Ashish S
Lindenfeld, JoAnn
Zalawadiya, Sandip K
Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title_full Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title_fullStr Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title_full_unstemmed Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title_short Transcatheter Aortic Valve Replacement and Surgical Aortic Valve Replacement Outcomes in Left Ventricular Assist Device Patients with Aortic Insufficiency
title_sort transcatheter aortic valve replacement and surgical aortic valve replacement outcomes in left ventricular assist device patients with aortic insufficiency
topic Treatment
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819997/
https://www.ncbi.nlm.nih.gov/pubmed/36644645
http://dx.doi.org/10.15420/cfr.2022.21
work_keys_str_mv AT ralianikets transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT tadurusivas transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT tranlenae transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT rankasagar transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT schlendorfkellyh transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT barkercolinm transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT shahashishs transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT lindenfeldjoann transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency
AT zalawadiyasandipk transcatheteraorticvalvereplacementandsurgicalaorticvalvereplacementoutcomesinleftventricularassistdevicepatientswithaorticinsufficiency