<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term d...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.</span></span>展开更多
Objective: To assess the ability of the logistic EuroSCORE to predict long- term mortality of patients undergoing isolated Surgical Aortic Valve Replacement (SAVR). Methods: A retrospective review of all patients unde...Objective: To assess the ability of the logistic EuroSCORE to predict long- term mortality of patients undergoing isolated Surgical Aortic Valve Replacement (SAVR). Methods: A retrospective review of all patients undergoing SAVR between September 1999, and March 2018 was done. Results: 2018 patients were eligible for inclusion in the study. Patients were grouped according to risk: low (n = 506), intermediate (n = 609), and high-risk (n = 903) depending on their logistic EuroSCORE values. The 30-day mortality of the low- risk group was 0.47%. The one-, five-, 10-, 15-, and 20-year mortality was 1.66%, 4.9%, 14.9%, 24.3%, and 43.8%, respectively. Intermediate-risk group 30-day mortality was 0.66%. The one-, five-, 10-, 15-, and 20-year mortality was 3.28%, 11.9%, 32%, 54.8%, and 82.6%, respectively. The 30-day mortality of the high- risk group was 3.99%. The one-, five-, 10-, 15-, and 20-year mortality was 8.2%, 27%, 55.4%, 78.6%, and 87%, respectively. Conclusion: Our results confirm that the lES is accurate in predicting long-term mortality outcomes of SAVR. This real-world data provides evidence of the potential usefulness of the EuroSCORE to help the heart team and patients decide on appropriate interventions for aortic stenosis.展开更多
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Despite expanding indications, data regarding the long-term durability of transcatheter heart valves (THV) are limited. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> We performed a systematic review and meta-analysis of all published studies with ≥5</span></span><span style="font-family:;" "=""></span><span style="font-family:;" "=""><span style="font-family:Verdana;">years of follow-up reporting aortic valve reintervention rates of transcatheter (TAVR) and surgical aortic valve replacement (SAVR). </span><span style="font-family:Verdana;">Randomized controlled trials (n = 4) and propensity-matched observational studies (n = 1) involving all surgical risk categories were included. The primary endpoint was the composite of aortic valve reintervention and death. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> The meta-</span></span><span style="font-family:Verdana;"> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">analysis included 4145 patients: 2101 underwent TAVR (mean age 81.7 ± 6.7 years, 54% male) and 2044 SAVR (mean age 81.8 ± 6.6 years, 54% male)</span><span style="font-family:Verdana;">. All TAVR procedures were performed with early</span></span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">generations of THV. At</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> a median follow-up of 5 years (range 5 - 6 years), TAVR had higher reintervention rates (odds ratio (OR) 3.33;95% CI: [1.78, 6.24], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 0%), all-cause mortality (OR 1.45;95% CI: [1.22, 1.75], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 44%) and the composite of reintervention and death (OR 1.47;95% CI: [1.14, 1.91], p < 0.001, I</span><sup><span style="font-size:12px;font-family:Verdana;">2</span></sup><span style="font-family:Verdana;"> = 64%). Rates of myocardial infarction, transient ischemic attack, stroke, endocarditis, and the composite of endocarditis and thrombosis were similar between the groups. </span><b><span style="font-family:Verdana;">Conclusion</span></b><span style="font-family:Verdana;">: Despite comparable short and medium-term results, TAVR with early-generation THV has higher rates of reintervention and the composite of reintervention and death. Further studies employing newer definitions of structural valve deterioration and bioprosthetic valve failure are needed to assess whether technological enhancements in THV technology will improve long-term outcomes.</span></span>
文摘Objective: To assess the ability of the logistic EuroSCORE to predict long- term mortality of patients undergoing isolated Surgical Aortic Valve Replacement (SAVR). Methods: A retrospective review of all patients undergoing SAVR between September 1999, and March 2018 was done. Results: 2018 patients were eligible for inclusion in the study. Patients were grouped according to risk: low (n = 506), intermediate (n = 609), and high-risk (n = 903) depending on their logistic EuroSCORE values. The 30-day mortality of the low- risk group was 0.47%. The one-, five-, 10-, 15-, and 20-year mortality was 1.66%, 4.9%, 14.9%, 24.3%, and 43.8%, respectively. Intermediate-risk group 30-day mortality was 0.66%. The one-, five-, 10-, 15-, and 20-year mortality was 3.28%, 11.9%, 32%, 54.8%, and 82.6%, respectively. The 30-day mortality of the high- risk group was 3.99%. The one-, five-, 10-, 15-, and 20-year mortality was 8.2%, 27%, 55.4%, 78.6%, and 87%, respectively. Conclusion: Our results confirm that the lES is accurate in predicting long-term mortality outcomes of SAVR. This real-world data provides evidence of the potential usefulness of the EuroSCORE to help the heart team and patients decide on appropriate interventions for aortic stenosis.
