Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature
Background: Very severe aortic stenosis (VSAS) is a critical condition with unfavourable clinical outcomes if left untreated or treated by surgical valve replacement. In contrast, after transcatheter valve implantation (TAVI) outcomes seem to be similar or – paradoxically – even better compared to s...
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Elsevier
2025-08-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906725001137 |
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| author | Matthias Hammerer Elke Boxhammer Erika Prinz Bernhard Scharinger Wilfried Wintersteller Uta C. Hoppe |
| author_facet | Matthias Hammerer Elke Boxhammer Erika Prinz Bernhard Scharinger Wilfried Wintersteller Uta C. Hoppe |
| author_sort | Matthias Hammerer |
| collection | DOAJ |
| description | Background: Very severe aortic stenosis (VSAS) is a critical condition with unfavourable clinical outcomes if left untreated or treated by surgical valve replacement. In contrast, after transcatheter valve implantation (TAVI) outcomes seem to be similar or – paradoxically – even better compared to severe aortic stenosis (SAS), as indicated by previous studies. Methods: Data of patients from a single centre who underwent TAVI were retrospectively analysed. Patients with concordant AS (n = 475) were divided into SAS (n = 379) and VSAS (n = 96) groups. These groups are compared in terms of procedural (safety) and long-term (efficacy) outcomes, using propensity score matching. In addition, a review of relevant literature is provided. Results: After propensity score matching, 96 patients remained in each group. Procedural outcomes did not differ significantly between VSAS and SAS groups. Cox proportional hazards regression analysis showed a favourable trend toward lower overall mortality within a mean follow-up of 42 months after TAVI in the VSAS group (hazard ratio, HR, 0.668; 95 % confidence interval, CI, 0.430–1.038). This difference did not reach statistical significance (p = 0.073), however, it was significant in the subgroups of females (p = 0.045) and patients with NYHA class III (p = 0.043). Conclusion: Our analysis confirms – in line with previous studies – that patients with VSAS represent a substantial subgroup and have at least as favourable or – paradoxically −even better clinical results after TAVI compared to patients with SAS. Therefore, TAVI should not be withheld from these patients. |
| format | Article |
| id | doaj-art-69f52b03b5ab48abb4d00ab7c97bc636 |
| institution | DOAJ |
| issn | 2352-9067 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj-art-69f52b03b5ab48abb4d00ab7c97bc6362025-08-20T02:56:29ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672025-08-015910171010.1016/j.ijcha.2025.101710Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literatureMatthias Hammerer0Elke Boxhammer1Erika Prinz2Bernhard Scharinger3Wilfried Wintersteller4Uta C. Hoppe5Department of Internal Medicine II, Division of Cardiology, Austria; Corresponding author at: Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.Department of Internal Medicine II, Division of Cardiology, AustriaDepartment of Internal Medicine II, Division of Cardiology, AustriaDepartment of Radiology Paracelsus Medical University of Salzburg Müllner Hauptstraße 48, 5020 Salzburg, AustriaDepartment of Internal Medicine II, Division of Cardiology, AustriaDepartment of Internal Medicine II, Division of Cardiology, AustriaBackground: Very severe aortic stenosis (VSAS) is a critical condition with unfavourable clinical outcomes if left untreated or treated by surgical valve replacement. In contrast, after transcatheter valve implantation (TAVI) outcomes seem to be similar or – paradoxically – even better compared to severe aortic stenosis (SAS), as indicated by previous studies. Methods: Data of patients from a single centre who underwent TAVI were retrospectively analysed. Patients with concordant AS (n = 475) were divided into SAS (n = 379) and VSAS (n = 96) groups. These groups are compared in terms of procedural (safety) and long-term (efficacy) outcomes, using propensity score matching. In addition, a review of relevant literature is provided. Results: After propensity score matching, 96 patients remained in each group. Procedural outcomes did not differ significantly between VSAS and SAS groups. Cox proportional hazards regression analysis showed a favourable trend toward lower overall mortality within a mean follow-up of 42 months after TAVI in the VSAS group (hazard ratio, HR, 0.668; 95 % confidence interval, CI, 0.430–1.038). This difference did not reach statistical significance (p = 0.073), however, it was significant in the subgroups of females (p = 0.045) and patients with NYHA class III (p = 0.043). Conclusion: Our analysis confirms – in line with previous studies – that patients with VSAS represent a substantial subgroup and have at least as favourable or – paradoxically −even better clinical results after TAVI compared to patients with SAS. Therefore, TAVI should not be withheld from these patients.http://www.sciencedirect.com/science/article/pii/S2352906725001137Severe aortic valve stenosisVery severe aortic valve stenosisTranscatheter aortic valve implantationClinical outcomesMortality |
| spellingShingle | Matthias Hammerer Elke Boxhammer Erika Prinz Bernhard Scharinger Wilfried Wintersteller Uta C. Hoppe Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature International Journal of Cardiology: Heart & Vasculature Severe aortic valve stenosis Very severe aortic valve stenosis Transcatheter aortic valve implantation Clinical outcomes Mortality |
| title | Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature |
| title_full | Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature |
| title_fullStr | Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature |
| title_full_unstemmed | Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature |
| title_short | Paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation? a propensity score matched analysis and review of literature |
| title_sort | paradoxical clinical outcomes of severe versus very severe aortic valve stenosis after transcatheter aortic valve implantation a propensity score matched analysis and review of literature |
| topic | Severe aortic valve stenosis Very severe aortic valve stenosis Transcatheter aortic valve implantation Clinical outcomes Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2352906725001137 |
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