PMID- 38236149
OWN - NLM
STAT- MEDLINE
DCOM- 20240429
LR  - 20240429
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 25
IP  - 5
DP  - 2024 Apr 30
TI  - Mixed aortic valve disease: association with paravalvular leak and reduced 
      survival after transcatheter aortic valve replacement.
PG  - 718-726
LID - 10.1093/ehjci/jeae005 [doi]
AB  - AIMS: Transcatheter aortic valve replacement (TAVR) revolutionized the therapy of 
      severe aortic stenosis (AS) with rising numbers. Mixed aortic valve disease 
      (MAVD) treated by TAVR is gaining more interest, as those patients represent a 
      more complex cohort as compared with isolated AS. However, concerning long-term 
      outcome for this cohort only, limited data are available. The aim of the study is 
      to assess the prevalence of MAVD in TAVR patients, investigate its association 
      with paravalvular regurgitation (PVR), and analyse its impact on long-term 
      mortality after TAVR. METHODS AND RESULTS: We conducted a registry-based cohort 
      study using the Vienna TAVR registry, enrolling patients who underwent TAVR at 
      Medical University of Vienna between January 2007 and May 2020 with available 
      transthoracic echocardiography before and after TAVR (n = 880). Data analysis 
      included PVR incidence and long-term survival outcomes. A total of 647 (73.52%) 
      out of 880 patients had >/= mild aortic regurgitation next to severe AS. MAVD was 
      associated with PVR compared with isolated AS with an odds ratio of 2.06, 95% 
      confidence interval (CI): 1.51-2.81 (P = <0.001). More than mild PVR after TAVR 
      (n = 168 out of 880: 19.09%) was related to higher mortality compared with the 
      absence of PVR with a hazard ratio (HR) of 1.33, 95% CI: 1.05- 1.67 (P = 0.016). 
      MAVD patients developing >/= mild PVR after TAVR were also associated with higher 
      mortality compared with the absence of PVR with an HR of 1.30 and 95% CI: 
      1.04-1.62 (P = 0.022). CONCLUSION: MAVD is prevalent among TAVR patients and 
      presents unique challenges, with increased PVR risk and worse outcomes compared 
      with isolated AS. Long-term survival for MAVD patients, not limited to those 
      developing PVR post-TAVR, is compromised. Earlier intervention before the 
      occurrence of structural myocardial damage or surgical valve replacement might be 
      a potential workaround to improve outcomes.
CI  - (c) The Author(s) 2024. Published by Oxford University Press on behalf of the 
      European Society of Cardiology. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Demirel, Caglayan
AU  - Demirel C
AUID- ORCID: 0009-0001-1966-0637
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Winter, Max Paul
AU  - Winter MP
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Nitsche, Christian
AU  - Nitsche C
AUID- ORCID: 0000-0002-0141-7639
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Koschatko, Sophia
AU  - Koschatko S
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Jantsch, Charlotte
AU  - Jantsch C
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Mascherbauer, Katharina
AU  - Mascherbauer K
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Halavina, Kseniya
AU  - Halavina K
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Heitzinger, Gregor
AU  - Heitzinger G
AUID- ORCID: 0000-0003-2094-0414
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Dona, Carolina
AU  - Dona C
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Dannenberg, Varius
AU  - Dannenberg V
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Spinka, Georg
AU  - Spinka G
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Koschutnik, Matthias
AU  - Koschutnik M
AUID- ORCID: 0000-0001-6164-8773
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Andreas, Martin
AU  - Andreas M
AD  - Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
FAU - Hengstenberg, Christian
AU  - Hengstenberg C
AUID- ORCID: 0000-0002-8284-2994
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
FAU - Bartko, Philipp E
AU  - Bartko PE
AUID- ORCID: 0000-0002-6937-7979
AD  - Department of Internal Medicine II, Clinical Division of Cardiology, Medical 
      University of Vienna, Waehringer Guertel 18-20A, 1090 Vienna, Austria.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
MH  - Humans
MH  - *Transcatheter Aortic Valve Replacement/adverse effects/methods
MH  - Female
MH  - Male
MH  - *Registries
MH  - Aged, 80 and over
MH  - Aged
MH  - Aortic Valve Insufficiency/diagnostic imaging/surgery/mortality
MH  - Aortic Valve Stenosis/surgery/diagnostic imaging/mortality
MH  - Echocardiography
MH  - Survival Rate
MH  - Retrospective Studies
MH  - Austria/epidemiology
MH  - Severity of Illness Index
MH  - Aortic Valve Disease/surgery/diagnostic imaging
MH  - Postoperative Complications/diagnostic imaging/epidemiology
MH  - Cohort Studies
MH  - Risk Assessment
MH  - Risk Factors
OTO - NOTNLM
OT  - mixed aortic valve disease
OT  - paravalvular regurgitation after TAVR
OT  - transcatheter aortic valve replacement
COIS- Conflict of interest: M.A. is a proctor/consultant/speaker (Edwards, Abbott, 
      Medtronic, Boston, AbbVie, Zoll) and received institutional research grants 
      (Edwards, Abbott, Medtronic, LSI). All other authors have no relationships 
      relevant to the contents of this article to disclose.
EDAT- 2024/01/18 12:41
MHDA- 2024/04/30 04:21
CRDT- 2024/01/18 10:03
PHST- 2023/12/26 00:00 [received]
PHST- 2023/12/29 00:00 [accepted]
PHST- 2024/04/30 04:21 [medline]
PHST- 2024/01/18 12:41 [pubmed]
PHST- 2024/01/18 10:03 [entrez]
AID - 7571308 [pii]
AID - 10.1093/ehjci/jeae005 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2024 Apr 30;25(5):718-726. doi: 
      10.1093/ehjci/jeae005.