PMID- 34673507
OWN - NLM
STAT- MEDLINE
DCOM- 20221110
LR  - 20221122
IS  - 1678-9741 (Electronic)
IS  - 0102-7638 (Print)
IS  - 0102-7638 (Linking)
VI  - 37
IP  - 5
DP  - 2022 Oct 8
TI  - High Residual Gradient Following a Self-Expandable Transcatheter Aortic 
      Valve-in-Valve Implantation - Risk Factor Analysis, Outcomes, and Survival.
PG  - 710-720
LID - 10.21470/1678-9741-2020-0424 [doi]
AB  - INTRODUCTION: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be 
      associated with unfavorable hemodynamic outcomes. This study aimed to estimate 
      the prevalence, identify the risk factors, and evaluate the outcomes and survival 
      of patients with high residual gradients after TAVI-ViV. METHODS: A total of 85 
      patients were included in the study. The cohort was divided into group A, with 
      postprocedural mean pressure gradient (PG) >/= 20 mmHg, and group B, with mean PG 
      < 20 mmHg. RESULTS: Postprocedural PG >/= 20 mmHg was observed in 24.7% of the 
      patients. In a univariate analysis, preoperative gradient, pre-existing 
      patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated 
      valves, and an older generation of transcatheter aortic valves were found to be 
      risk factors for high residual gradient. Multivariate analysis showed that 
      preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and 
      degenerated valve size </= 23 mm were independent predictors of high residual 
      gradient. There were no differences in early morbidity (myocardial infarction, 
      pacemaker implantation, stroke, acute renal insufficiency) between groups. 
      Kaplan-Meier estimated that the survival rate was comparable at one and five 
      years regardless of postoperative gradient. Survivors with high residual mean 
      gradient were significantly affected by a high New York Heart Association (NYHA) 
      class. CONCLUSION: High residual transvalvular gradient after TAVI-ViV is not 
      rare, but it does not significantly affect mortality. High residual mean gradient 
      has a negative impact on NYHA functional class improvement after the procedure. 
      High preoperative gradient, implantation level, and small failed bioprosthesis 
      may predispose to increased residual gradient.
FAU - Stankowski, Tomasz
AU  - Stankowski T
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Aboul-Hassan, Sleiman Sebastian
AU  - Aboul-Hassan SS
AUID- ORCID: 0000-0003-4544-7466
AD  - Department of Cardiac Surgery, Medinet Heart Center Ltd., Nowa Sol, Poland.
FAU - Stepinski, Piotr
AU  - Stepinski P
AD  - Department of Cardiac Surgery, Lodz Medical University, Lodz, Poland.
FAU - Gasior, Tomasz
AU  - Gasior T
AD  - Division of Cardiology and Structural Heart Diseases, Medical University of 
      Silesia, Katowice, Poland.
FAU - Salem, Mohammed
AU  - Salem M
AD  - Department of Cardiology, Carl-Thiem-Klinikum, Cottbus, Germany.
FAU - Erkenov, Temirlan
AU  - Erkenov T
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Herwig, Volker
AU  - Herwig V
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Harnath, Axel
AU  - Harnath A
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Muehle, Anja
AU  - Muehle A
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Sa, Michel Pompeu B O
AU  - Sa MPBO
AD  - Division of Cardiovascular Surgery, Pronto-Socorro Cardiologico de Pernambuco 
      (PROCAPE), Universidade de Pernambuco, Recife, Pernambuco, Brazil.
FAU - Fritzsche, Dirk
AU  - Fritzsche D
AD  - Department of Cardiac Surgery, Sana Heart Center Cottbus, Cottbus, Germany.
FAU - Perek, Bartlomiej
AU  - Perek B
AD  - Department of Cardiac Surgery and Transplantology, Poznan University of Medical 
      Sciences, Poznan, Poland.
LA  - eng
PT  - Journal Article
DEP - 20221008
PL  - Brazil
TA  - Braz J Cardiovasc Surg
JT  - Brazilian journal of cardiovascular surgery
JID - 101677045
SB  - IM
MH  - Humans
MH  - Aortic Valve/surgery
MH  - *Heart Valve Prosthesis/adverse effects
MH  - *Aortic Valve Stenosis/surgery
MH  - Prosthesis Failure
MH  - Prosthesis Design
MH  - Treatment Outcome
MH  - *Bioprosthesis/adverse effects
MH  - *Transcatheter Aortic Valve Replacement/adverse effects/methods
MH  - *Heart Valve Prosthesis Implantation/methods
MH  - Risk Factors
MH  - Factor Analysis, Statistical
PMC - PMC9670351
OTO - NOTNLM
OT  - Bioprosthesis
OT  - Hear Valve Prosthesis
OT  - Myocardial Infarctation
OT  - Risk Factors
OT  - Survival Rate
OT  - Survivors
COIS- No conflict of interest.
EDAT- 2021/10/22 06:00
MHDA- 2022/11/11 06:00
PMCR- 2022/09/01
CRDT- 2021/10/21 21:07
PHST- 2021/10/22 06:00 [pubmed]
PHST- 2022/11/11 06:00 [medline]
PHST- 2021/10/21 21:07 [entrez]
PHST- 2022/09/01 00:00 [pmc-release]
AID - 10.21470/1678-9741-2020-0424 [doi]
PST - epublish
SO  - Braz J Cardiovasc Surg. 2022 Oct 8;37(5):710-720. doi: 
      10.21470/1678-9741-2020-0424.