Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome?
Background No data currently exist comparing the contemporary iterations of balloon‐expandable (BE) Edwards SAPIEN 3/Ultra and the self‐expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aor...
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2023-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.028038 |
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| author | Konstantinos Kalogeras Richard J. Jabbour Radoslaw Pracon Tito Kabir Joanne Shannon Alison Duncan Cesare Quarto Ee‐Ling Heng Hazim Rahbi Evangelos Oikonomou Efstratios Katsianos Niket Patel Navin Chandra Michael‐Andrew Vavuranakis Suzane Cadiz Maria Bougiakli Robert D. Smith Gerasimos Siasos Manolis Vavuranakis Simon Davies Miles Dalby Vasileios Panoulas |
| author_facet | Konstantinos Kalogeras Richard J. Jabbour Radoslaw Pracon Tito Kabir Joanne Shannon Alison Duncan Cesare Quarto Ee‐Ling Heng Hazim Rahbi Evangelos Oikonomou Efstratios Katsianos Niket Patel Navin Chandra Michael‐Andrew Vavuranakis Suzane Cadiz Maria Bougiakli Robert D. Smith Gerasimos Siasos Manolis Vavuranakis Simon Davies Miles Dalby Vasileios Panoulas |
| author_sort | Konstantinos Kalogeras |
| collection | DOAJ |
| description | Background No data currently exist comparing the contemporary iterations of balloon‐expandable (BE) Edwards SAPIEN 3/Ultra and the self‐expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all‐cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow‐up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog‐rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog‐rank=0.042). In propensity‐matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog‐rank=0.096). Conclusions Real‐world comparison of the latest‐generation SE and BE devices demonstrated similar survival up to 3 years’ follow‐up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves. |
| format | Article |
| id | doaj-art-0d9720131b9e4c43aafa17ff41a746bd |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-0d9720131b9e4c43aafa17ff41a746bd2025-08-20T02:24:46ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-06-01121110.1161/JAHA.122.028038Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome?Konstantinos Kalogeras0Richard J. Jabbour1Radoslaw Pracon2Tito Kabir3Joanne Shannon4Alison Duncan5Cesare Quarto6Ee‐Ling Heng7Hazim Rahbi8Evangelos Oikonomou9Efstratios Katsianos10Niket Patel11Navin Chandra12Michael‐Andrew Vavuranakis13Suzane Cadiz14Maria Bougiakli15Robert D. Smith16Gerasimos Siasos17Manolis Vavuranakis18Simon Davies19Miles Dalby20Vasileios Panoulas21Department of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UK3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens GreeceDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UK3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens GreeceDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UK3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens Greece3rd Department of Cardiology, Sotiria Hospital, Medical School National and Kapodistrian University of Athens Athens GreeceDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKDepartment of Cardiology, Royal Brompton and Harefield Hospitals Guy’s and St Thomas’ National Health Service Foundation Trust London UKBackground No data currently exist comparing the contemporary iterations of balloon‐expandable (BE) Edwards SAPIEN 3/Ultra and the self‐expanding (SE) Medtronic Evolut PRO/R34 valves. The aim of the study was the comparison of these transcatheter heart valves with emphasis on patients with small aortic annulus. Methods and Results In this retrospective registry, periprocedural outcomes and midterm all‐cause mortality were analyzed. A total of 1673 patients (917 SE versus 756 BE) were followed up for a median of 15 months. A total of 194 patients died (11.6%) during follow‐up. SE and BE groups showed similar survival at 1 (92.6% versus 90.6%) and 3 (80.3% versus 85.2%) years (Plog‐rank=0.136). Compared with the BE group, patients treated with the SE device had lower peak (16.3±8 mm Hg SE versus 21.9±8 mm Hg BE) and mean (8.8±5 mm Hg SE versus 11.5±5 mm Hg BE) gradients at discharge. Conversely, the BE group demonstrated lower rates of at least moderate paravalvular regurgitation postoperatively (5.6% versus 0.7% for SE and BE valves, respectively; P<0.001). In patients treated with small transcatheter heart valves (≤26 mm for SE and ≤23 mm for BE; N=284 for SE and N=260 for BE), survival was higher among patients treated with SE valves at both 1 (96.7% SE versus 92.1% BE) and 3 (91.8% SE versus 82.2% BE) years (Plog‐rank=0.042). In propensity‐matched patients treated with small transcatheter heart valve, there remained a trend for higher survival among the SE group at both 1 (97% SE versus 92.3% BE) and 3 years (91.8% SE versus 78.7% BE), Plog‐rank=0.096). Conclusions Real‐world comparison of the latest‐generation SE and BE devices demonstrated similar survival up to 3 years’ follow‐up. In patients with small transcatheter heart valves, there may be a trend for improved survival among those treated with SE valves.https://www.ahajournals.org/doi/10.1161/JAHA.122.028038balloon expandableparavalvular regurgitationself‐expandingsmall transcatheter heart valvetranscatheter aortic valve implantation |
| spellingShingle | Konstantinos Kalogeras Richard J. Jabbour Radoslaw Pracon Tito Kabir Joanne Shannon Alison Duncan Cesare Quarto Ee‐Ling Heng Hazim Rahbi Evangelos Oikonomou Efstratios Katsianos Niket Patel Navin Chandra Michael‐Andrew Vavuranakis Suzane Cadiz Maria Bougiakli Robert D. Smith Gerasimos Siasos Manolis Vavuranakis Simon Davies Miles Dalby Vasileios Panoulas Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease balloon expandable paravalvular regurgitation self‐expanding small transcatheter heart valve transcatheter aortic valve implantation |
| title | Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? |
| title_full | Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? |
| title_fullStr | Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? |
| title_full_unstemmed | Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? |
| title_short | Midterm Outcomes in Patients With Aortic Stenosis Treated With Contemporary Balloon‐Expandable and Self‐Expanding Valves: Does Valve Size Have an Impact on Outcome? |
| title_sort | midterm outcomes in patients with aortic stenosis treated with contemporary balloon expandable and self expanding valves does valve size have an impact on outcome |
| topic | balloon expandable paravalvular regurgitation self‐expanding small transcatheter heart valve transcatheter aortic valve implantation |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.028038 |
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