Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective
Objective: To compare outcomes of aortic valve replacement (AVR) in patients with pure aortic stenosis (Pure AS) and those with pure aortic regurgitation (Pure AR) or mixed AS and AR (MAVD) in the COMMENCE trial. Methods: Of 689 patients who underwent AVR in the COMMENCE trial, patients with moderat...
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Elsevier
2024-12-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273624002481 |
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| author | Vinod H. Thourani, MD John D. Puskas, MD Bartley Griffith, MD Lars G. Svensson, MD, PhD Philippe Pibarot, DVM, PhD Michael A. Borger, MD, PhD David Heimansohn, MD Thomas Beaver, MD, MPH Eugene H. Blackstone, MD Anna Liza M. Antonio, DrPH Joseph E. Bavaria, MD, MPH |
| author_facet | Vinod H. Thourani, MD John D. Puskas, MD Bartley Griffith, MD Lars G. Svensson, MD, PhD Philippe Pibarot, DVM, PhD Michael A. Borger, MD, PhD David Heimansohn, MD Thomas Beaver, MD, MPH Eugene H. Blackstone, MD Anna Liza M. Antonio, DrPH Joseph E. Bavaria, MD, MPH |
| author_sort | Vinod H. Thourani, MD |
| collection | DOAJ |
| description | Objective: To compare outcomes of aortic valve replacement (AVR) in patients with pure aortic stenosis (Pure AS) and those with pure aortic regurgitation (Pure AR) or mixed AS and AR (MAVD) in the COMMENCE trial. Methods: Of 689 patients who underwent AVR in the COMMENCE trial, patients with moderate or severe AR with or without AS (Pure AR + MAVD; n = 135) or Pure AS (n = 323) were included. Inverse probability of treatment weighting Kaplan-Meier survival curves were used for time-to-event endpoints, and longitudinal changes in hemodynamics were evaluated using mixed-effects models. Echocardiographic outcomes were assessed by an echo core laboratory and clinical outcomes adjudicated by a clinical events committee. The mean duration of follow-up was 5.3 ± 2.2 years. Results: At 5 years, adjusted safety endpoints were not statistically different between groups; no structural valve deterioration (SVD) event occurred in either group. After adjustment, the Pure AR + MAVD group had a greater change in body surface area–corrected left ventricular (LV) mass reduction (P = .03) compared to the Pure AS patients. Those patients with a baseline LV ejection fraction (LVEF) >55% continued to demonstrate preserved contractility compared to patients with an LVEF ≤55% at baseline (P < .0001). No significant difference in mean gradient (P = .07) or effective orifice area (P = .96) at 5 years was evident between the groups. Conclusions: Patients with Pure AR + MAVD demonstrated similar clinical safety and freedom from SVD at 5 years compared to those with Pure AS. There was a significant difference in LV reverse remodeling in the Pure AR + MAVD group compared to the Pure AS group at 5 years. These favorable outcomes in patients with AR may reinforce the need for treatment before irreversible changes occur. |
| format | Article |
| id | doaj-art-56f4ab2f322a4a6bb988a384b657d7e3 |
| institution | OA Journals |
| issn | 2666-2736 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
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| series | JTCVS Open |
| spelling | doaj-art-56f4ab2f322a4a6bb988a384b657d7e32025-08-20T01:56:23ZengElsevierJTCVS Open2666-27362024-12-012216017310.1016/j.xjon.2024.08.020Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspectiveVinod H. Thourani, MD0John D. Puskas, MD1Bartley Griffith, MD2Lars G. Svensson, MD, PhD3Philippe Pibarot, DVM, PhD4Michael A. Borger, MD, PhD5David Heimansohn, MD6Thomas Beaver, MD, MPH7Eugene H. Blackstone, MD8Anna Liza M. Antonio, DrPH9Joseph E. Bavaria, MD, MPH10Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga; Address for reprints: Vinod H. Thourani, MD, Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, 95 Collier Rd, Ste 5015, Atlanta, GA 30309.Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GaDepartment of Surgery, University of Maryland Medical Center, Baltimore, MdDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OhioDepartment of Cardiology, Québec Heart and Lung Institute, Laval University, Quebec, CanadaUniversity Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, GermanyDepartment of Cardiothoracic Surgery, St. Vincent Heart Center of Indiana, Indianapolis, IndDivision of Cardiovascular Surgery, University of Florida Health, Gainesville, FlaDepartment of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OhioDepartment of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga; Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga; Department of Surgery, University of Maryland Medical Center, Baltimore, Md; Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Cardiology, Québec Heart and Lung Institute, Laval University, Quebec, Canada; University Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany; Department of Cardiothoracic Surgery, St. Vincent Heart Center of Indiana, Indianapolis, Ind; Division of Cardiovascular Surgery, University of Florida Health, Gainesville, Fla; Edwards Lifesciences, Irvine, Calif; Department of Cardiovascular Surgery, Jefferson Health, Philadelphia, PaDepartment of Cardiovascular Surgery, Jefferson Health, Philadelphia, PaObjective: To compare outcomes of aortic valve replacement (AVR) in patients with pure aortic stenosis (Pure AS) and those with pure aortic regurgitation (Pure AR) or mixed AS and AR (MAVD) in the COMMENCE trial. Methods: Of 689 patients who underwent AVR in the COMMENCE trial, patients with moderate or severe AR with or without AS (Pure AR + MAVD; n = 135) or Pure AS (n = 323) were included. Inverse probability of treatment weighting Kaplan-Meier survival curves were used for time-to-event endpoints, and longitudinal changes in hemodynamics were evaluated using mixed-effects models. Echocardiographic outcomes were assessed by an echo core laboratory and clinical outcomes adjudicated by a clinical events committee. The mean duration of follow-up was 5.3 ± 2.2 years. Results: At 5 years, adjusted safety endpoints were not statistically different between groups; no structural valve deterioration (SVD) event occurred in either group. After adjustment, the Pure AR + MAVD group had a greater change in body surface area–corrected left ventricular (LV) mass reduction (P = .03) compared to the Pure AS patients. Those patients with a baseline LV ejection fraction (LVEF) >55% continued to demonstrate preserved contractility compared to patients with an LVEF ≤55% at baseline (P < .0001). No significant difference in mean gradient (P = .07) or effective orifice area (P = .96) at 5 years was evident between the groups. Conclusions: Patients with Pure AR + MAVD demonstrated similar clinical safety and freedom from SVD at 5 years compared to those with Pure AS. There was a significant difference in LV reverse remodeling in the Pure AR + MAVD group compared to the Pure AS group at 5 years. These favorable outcomes in patients with AR may reinforce the need for treatment before irreversible changes occur.http://www.sciencedirect.com/science/article/pii/S2666273624002481aortic stenosisaortic regurgitationmixed aortic valve diseaseaortic valve replacementclinical outcomes |
| spellingShingle | Vinod H. Thourani, MD John D. Puskas, MD Bartley Griffith, MD Lars G. Svensson, MD, PhD Philippe Pibarot, DVM, PhD Michael A. Borger, MD, PhD David Heimansohn, MD Thomas Beaver, MD, MPH Eugene H. Blackstone, MD Anna Liza M. Antonio, DrPH Joseph E. Bavaria, MD, MPH Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective JTCVS Open aortic stenosis aortic regurgitation mixed aortic valve disease aortic valve replacement clinical outcomes |
| title | Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective |
| title_full | Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective |
| title_fullStr | Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective |
| title_full_unstemmed | Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective |
| title_short | Five-year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the COMMENCE trialCentral MessagePerspective |
| title_sort | five year comparison of clinical and echocardiographic outcomes of pure aortic stenosis with pure aortic regurgitation or mixed aortic valve disease in the commence trialcentral messageperspective |
| topic | aortic stenosis aortic regurgitation mixed aortic valve disease aortic valve replacement clinical outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S2666273624002481 |
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