Universität zu Köln

Bleiziffer, Sabine, Erlebach, Magdalena, Simonato, Matheus, Pibarot, Philippe, Webb, John, Capek, Lukas, Windecker, Stephan, George, Isaac, Sinning, Jan-Malte, Horlick, Eric ORCID: 0000-0003-1303-0586, Napodano, Massimo, Holzhey, David M., Petursson, Petur, Cerillo, Alfredo, Bonaros, Nikolaos, Ferrari, Enrico ORCID: 0000-0002-2837-3242, Cohen, Mauricio G. ORCID: 0000-0003-2038-6070, Baquero, Giselle, Jones, Tara L., Kalra, Ankur, Reardon, Michael J., Chhatriwalla, Adnan, Gama Ribeiro, Vasco, Alnasser, Sami, Van Mieghem, Nicolas M., Rustenbach, Christian Joerg, Schofer, Joachim, Garcia, Santiago, Zeus, Tobias, Champagnac, Didier, Bekeredjian, Raffi, Kornowski, Ran, Lange, Ruediger and Dvir, Danny (2018). Incidence, predictors and clinical outcomes of residual stenosis after aortic valve-in-valve. Heart, 104 (10). S. 828 - 835. LONDON: BMJ PUBLISHING GROUP. ISSN 1468-201X

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Abstract

Objective We aimed to analyse the incidence of prosthesis-patient mismatch (PPM) and elevated gradients after aortic valve in valve (ViV), and to evaluate predictors and associations with clinical outcomes of this adverse event. Methods A total of 910 aortic ViV patients were investigated. Elevated residual gradients were defined as >= 20mm Hg. PPM was identified based on the indexed effective orifice area (EOA), measured by echocardiography, and patient body mass index (BMI). Moderate and severe PPM (cases) were defined by European Association of Cardiovascular Imaging (EACVI) criteria and compared with patients without PPM (controls). Results Moderate or greater PPM was found in 61% of the patients, and severe in 24.6%. Elevated residual gradients were found in 27.9%. Independent risk factors for the occurrence of lower indexed EOA and therefore severe PPM were higher gradients of the failed bioprosthesis at baseline (unstandardised beta -0.023; 95% CI -0.032 to -0.014; P<0.001), a stented (vs a stentless) surgical bioprosthesis (unstandardised beta -0.11; 95% CI -0.161 to -0.071; P<0.001), higher BMI (unstandardised beta -0.01; 95% CI -0.013 to -0.007; P<0.001) and implantation of a SAPIEN/SAPIEN XT/SAPIEN 3 transcatheter device (unstandardised beta -0.064; 95% CI -0.095 to -0.032; P<0.001). Neither severe PPM nor elevated gradients had an association with VARC II-defined outcomes or 1-year survival (90.9% severe vs 91.5% moderate vs 89.3% none, P=0.44). Conclusions Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Bleiziffer, Sabine UNSPECIFIED UNSPECIFIED UNSPECIFIED Erlebach, Magdalena UNSPECIFIED UNSPECIFIED UNSPECIFIED Simonato, Matheus UNSPECIFIED UNSPECIFIED UNSPECIFIED Pibarot, Philippe UNSPECIFIED UNSPECIFIED UNSPECIFIED Webb, John UNSPECIFIED UNSPECIFIED UNSPECIFIED Capek, Lukas UNSPECIFIED UNSPECIFIED UNSPECIFIED Windecker, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED George, Isaac UNSPECIFIED UNSPECIFIED UNSPECIFIED Sinning, Jan-Malte UNSPECIFIED UNSPECIFIED UNSPECIFIED Horlick, Eric UNSPECIFIED orcid.org/0000-0003-1303-0586 UNSPECIFIED Napodano, Massimo UNSPECIFIED UNSPECIFIED UNSPECIFIED Holzhey, David M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Petursson, Petur UNSPECIFIED UNSPECIFIED UNSPECIFIED Cerillo, Alfredo UNSPECIFIED UNSPECIFIED UNSPECIFIED Bonaros, Nikolaos UNSPECIFIED UNSPECIFIED UNSPECIFIED Ferrari, Enrico UNSPECIFIED orcid.org/0000-0002-2837-3242 UNSPECIFIED Cohen, Mauricio G. UNSPECIFIED orcid.org/0000-0003-2038-6070 UNSPECIFIED Baquero, Giselle UNSPECIFIED UNSPECIFIED UNSPECIFIED Jones, Tara L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kalra, Ankur UNSPECIFIED UNSPECIFIED UNSPECIFIED Reardon, Michael J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chhatriwalla, Adnan UNSPECIFIED UNSPECIFIED UNSPECIFIED Gama Ribeiro, Vasco UNSPECIFIED UNSPECIFIED UNSPECIFIED Alnasser, Sami UNSPECIFIED UNSPECIFIED UNSPECIFIED Van Mieghem, Nicolas M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rustenbach, Christian Joerg UNSPECIFIED UNSPECIFIED UNSPECIFIED Schofer, Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Garcia, Santiago UNSPECIFIED UNSPECIFIED UNSPECIFIED Zeus, Tobias UNSPECIFIED UNSPECIFIED UNSPECIFIED Champagnac, Didier UNSPECIFIED UNSPECIFIED UNSPECIFIED Bekeredjian, Raffi UNSPECIFIED UNSPECIFIED UNSPECIFIED Kornowski, Ran UNSPECIFIED UNSPECIFIED UNSPECIFIED Lange, Ruediger UNSPECIFIED UNSPECIFIED UNSPECIFIED Dvir, Danny UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-186933
DOI:	10.1136/heartjnl-2017-312422
Journal or Publication Title:	Heart
Volume:	104
Number:	10
Page Range:	S. 828 - 835
Date:	2018
Publisher:	BMJ PUBLISHING GROUP
Place of Publication:	LONDON
ISSN:	1468-201X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROSTHESIS-PATIENT MISMATCH; BIOPROSTHETIC SURGICAL VALVES; HIGH-RISK PATIENTS; TRANSCATHETER; REPLACEMENT; IMPLANTATION; IMPACT; ASSOCIATION; SURVIVAL; REGISTRY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/18693