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Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial.

Publication ,  Journal Article
Elmariah, S; Fearon, WF; Inglessis, I; Vlahakes, GJ; Lindman, BR; Alu, MC; Crowley, A; Kodali, S; Leon, MB; Svensson, L; Pibarot, P; Hahn, RT ...
Published in: JACC Cardiovasc Interv
December 11, 2017

OBJECTIVES: The authors sought to evaluate the impact of transapical (TA) transcatheter aortic valve replacement (TAVR) on mortality, left ventricular (LV) ejection fraction (LVEF) improvement, and functional recovery in patients with LV dysfunction. BACKGROUND: LV injury inherent to TA access for structural heart disease interventions may be particularly detrimental to the LV, functional recovery, and survival in patients with LV dysfunction. METHODS: The study included patients enrolled within the PARTNER I (Placement of Aortic Transcatheter Valves) trial that underwent transfemoral (TF) or TA TAVR. Analyses of clinical outcomes were stratified by the presence of baseline LV dysfunction (LVEF<50%) and adjusted for the propensity of receiving TA TAVR. RESULTS: Of 2,084 subjects, 1,057 underwent TA TAVR. TA access was associated with increased 2-year all-cause mortality in those with (adjusted hazard ratio [HRadjusted]: 1.52; 95% confidence interval [CI]: 1.12 to 2.07; p = 0.008) and without (HRadjusted: 1.38; 95% CI: 1.10 to 1.74; p = 0.006) LV dysfunction. TA TAVR portended increased 2-year cardiac mortality in subjects with LVEF<50% (HRadjusted: 1.92; 95% CI: 1.21 to 3.05; p = 0.006), but not with LVEF≥50% (HRadjusted: 1.29; 95% CI: 0.87 to 1.90; p = 0.21). In those with LVEF<50%, greater improvements in LVEF (TF-TA difference +4.04%, 95% CI: 2.39% to 5.69%; p < 0.0001) and 6-min walk distance (TF-TA difference +45.1 m, 95% CI: 18.4 to 71.9 m; p = 0.001) occurred within 30 days after TF versus TA TAVR. CONCLUSIONS: Compared with TF TAVR, TA TAVR is associated with a disproportionate risk of cardiac mortality in patients with LV dysfunction and with delayed and less robust improvement in LV function and overall functional status. Caution is warranted when considering TA access for structural heart disease interventions, particularly in patients with LV dysfunction. (Placement of Aortic Transcatheter Valves [PARTNER]; NCT00530894).

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

December 11, 2017

Volume

10

Issue

23

Start / End Page

2414 / 2422

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Stroke Volume
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries
 

Citation

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Elmariah, S., Fearon, W. F., Inglessis, I., Vlahakes, G. J., Lindman, B. R., Alu, M. C., … PARTNER Trial Investigators and PARTNER Publications Office, . (2017). Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial. JACC Cardiovasc Interv, 10(23), 2414–2422. https://doi.org/10.1016/j.jcin.2017.09.023
Elmariah, Sammy, William F. Fearon, Ignacio Inglessis, Gus J. Vlahakes, Brian R. Lindman, Maria C. Alu, Aaron Crowley, et al. “Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial.JACC Cardiovasc Interv 10, no. 23 (December 11, 2017): 2414–22. https://doi.org/10.1016/j.jcin.2017.09.023.
Elmariah S, Fearon WF, Inglessis I, Vlahakes GJ, Lindman BR, Alu MC, et al. Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial. JACC Cardiovasc Interv. 2017 Dec 11;10(23):2414–22.
Elmariah, Sammy, et al. “Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial.JACC Cardiovasc Interv, vol. 10, no. 23, Dec. 2017, pp. 2414–22. Pubmed, doi:10.1016/j.jcin.2017.09.023.
Elmariah S, Fearon WF, Inglessis I, Vlahakes GJ, Lindman BR, Alu MC, Crowley A, Kodali S, Leon MB, Svensson L, Pibarot P, Hahn RT, Thourani VH, Palacios IF, Miller DC, Douglas PS, Passeri JJ, PARTNER Trial Investigators and PARTNER Publications Office. Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction: Insights From the PARTNER I Trial. JACC Cardiovasc Interv. 2017 Dec 11;10(23):2414–2422.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

December 11, 2017

Volume

10

Issue

23

Start / End Page

2414 / 2422

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Stroke Volume
  • Severity of Illness Index
  • Risk Factors
  • Risk Assessment
  • Registries