Long-Term Bioprosthetic Valve Durability After Transcatheter Aortic Valve Replacement With Supra-Annular Self-Expanding Versus Intra-Annular Balloon-Expandable Valves in Patients With a Small Aortic Annulus

被引:1
作者
Matsuhiro, Yutaka [1 ]
Mizote, Isamu [1 ]
Nakamura, Daisuke [1 ]
Dohi, Tomoharu [1 ]
Maeda, Koichi [2 ]
Shimamura, Kazuo [2 ]
Kawamura, Ai [2 ]
Yamashita, Kizuku [2 ]
Kosugi, Shumpei [1 ]
Okuno, Shota [1 ]
Sugae, Hiroki [1 ]
Takeda, Yasuharu [1 ]
Sakata, Yasushi [1 ]
机构
[1] Osaka Univ, Grad Sch Med, Dept Cardiovasc Med, Osaka, Japan
[2] Osaka Univ, Grad Sch Med, Dept Cardiovasc Surg, Osaka, Japan
关键词
bioprosthetic valve failure; small aortic annulus; structural valve deterioration; transcatheter aortic valve replacement; DETERIORATION;
D O I
10.1002/ccd.31415
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundThe long-term valve durability of supra-annular self-expanding valves (SEV) and intra-annular balloon-expandable valves (BEV) in patients with small aortic annuli remains unexplored.AimsThis study aimed to determine the long-term bioprosthetic valve durability with SEV versus BEV in patients with small aortic annuli.MethodsThis retrospective study included patients with severe aortic stenosis (AS) and an aortic annulus area of 430 mm2 or less who underwent transcatheter aortic valve replacement using SEV and BEV between October 2009 and December 2022. Based on the Valve Academic Research Consortium's three definitions, the endpoints were hemodynamic structural valve deterioration (SVD) and bioprosthetic valve failure (BVF). Inverse probability of treatment weighting (IPTW) was used to compare between the two groups and adjust for baseline characteristics. The Fine-Gray subdistribution hazard model accounted for the competing risk of death.ResultsIn total, 565 patients (204 treated with SEV and 361 treated with BEV) were included. The median follow-up duration was 3.6 years [2.0 years, 5.7 years], and the maximum was 12.3 years. Hemodynamic SVD and BVF were less frequently identified in the SEV group than in the BEV group (1.1% vs. 9.1% within 5 years, 0.7% vs. 8.1% within 5 years, respectively). On the IPTW adjusted Fine-Gray subdistribution hazard model analysis, hemodynamic SVD was less frequent in SEV compared with BEV (Hazard Ratio [HR]: 0.16; 95% Confidence Interval [CI]: 0.04-0.56, p = 0.004). SEV was also associated with a lower BVF risk than BEV (HR: 0.25; 95% CI: 0.08-0.76, p = 0.015).ConclusionsSEV appears to be more suitable for long-term valve durability in patients with a small aortic annulus.
引用
收藏
页码:990 / 997
页数:8
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