Paravalvular Leak after Transcatheter Aortic Valve Implantation: Results from 3,600 patients.

IF 3.6 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Annals of Thoracic Surgery Pub Date : 2025-01-29 DOI:10.1016/j.athoracsur.2025.01.012

Nav Warraich, James A Brown, Eishan Ashwat, Dustin Kliner, Derek Serna-Gallegos, Catalin Toma, David West, Amber Makani, Yisi Wang, Ibrahim Sultan

{"title":"Paravalvular Leak after Transcatheter Aortic Valve Implantation: Results from 3,600 patients.","authors":"Nav Warraich, James A Brown, Eishan Ashwat, Dustin Kliner, Derek Serna-Gallegos, Catalin Toma, David West, Amber Makani, Yisi Wang, Ibrahim Sultan","doi":"10.1016/j.athoracsur.2025.01.012","DOIUrl":null,"url":null,"abstract":"Background: Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. Mild PVL remains prevalent post-TAVI and its impact on long-term survival is unclear. This study aims to examine the incidence, impact on survival, and progression of PVL.Methods: This was a retrospective, single-institution cohort study of TAVIs between 11/2012-1/2023. Patients were stratified by 30-day PVL severity: none/trace, mild, and ≥ moderate. Multivariable logistic regression was performed to identify risk factors associated with increasing PVL severity. Kaplan-Meier survival estimation and Cox proportional hazards regression were performed.Results: 3600 patients underwent TAVI. Of these, 2719 (75.5%) had none/trace PVL, 808 (22.5%) had mild PVL, and 73 (2.0%) had ≥ moderate PVL at 30-days. On multivariable logistic regression, later years of valve implantation (2017-2023) were protective against PVL progression. Kaplan-Meier estimates of the three groups were significantly different (p<0.001) with the ≥ moderate group having reduced survival. On Cox regression, ≥ moderate PVL was associated with increased mortality (HR = 1.80, 95% Cl, 1.31-2.46, p<0.001) while mild PVL was not (HR = 1.01; 95% CI, 0.89-1.15; p=0.88) compared to none/trace PVL. For Kaplan-Meier estimates comparing the none/trace and mild PVL groups alone, landmark analysis showed reduced survival in the mild PVL group after 2-years (p=0.03); however, this late reduction in survival in the mild PVL group did not persist on multivariable analysis (p=0.14).Conclusions: After TAVI, ≥ moderate PVL is associated with reduced survival compared to none/trace PVL. Mild PVL may result in a delayed survival reduction.","PeriodicalId":50976,"journal":{"name":"Annals of Thoracic Surgery","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Thoracic Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.athoracsur.2025.01.012","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Paravalvular leak (PVL) after transcatheter aortic valve implantation (TAVI) is associated with poor outcomes. Mild PVL remains prevalent post-TAVI and its impact on long-term survival is unclear. This study aims to examine the incidence, impact on survival, and progression of PVL.

Methods: This was a retrospective, single-institution cohort study of TAVIs between 11/2012-1/2023. Patients were stratified by 30-day PVL severity: none/trace, mild, and ≥ moderate. Multivariable logistic regression was performed to identify risk factors associated with increasing PVL severity. Kaplan-Meier survival estimation and Cox proportional hazards regression were performed.

Results: 3600 patients underwent TAVI. Of these, 2719 (75.5%) had none/trace PVL, 808 (22.5%) had mild PVL, and 73 (2.0%) had ≥ moderate PVL at 30-days. On multivariable logistic regression, later years of valve implantation (2017-2023) were protective against PVL progression. Kaplan-Meier estimates of the three groups were significantly different (p<0.001) with the ≥ moderate group having reduced survival. On Cox regression, ≥ moderate PVL was associated with increased mortality (HR = 1.80, 95% Cl, 1.31-2.46, p<0.001) while mild PVL was not (HR = 1.01; 95% CI, 0.89-1.15; p=0.88) compared to none/trace PVL. For Kaplan-Meier estimates comparing the none/trace and mild PVL groups alone, landmark analysis showed reduced survival in the mild PVL group after 2-years (p=0.03); however, this late reduction in survival in the mild PVL group did not persist on multivariable analysis (p=0.14).

Conclusions: After TAVI, ≥ moderate PVL is associated with reduced survival compared to none/trace PVL. Mild PVL may result in a delayed survival reduction.

查看原文本刊更多论文

求助全文

约1分钟内获得全文求助全文

来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.