NCDR Study Finds Low Incidence of VHD After TAVR

Incidence of valve hemodynamic deterioration (VHD) as reported in clinical practice is low, according to featured clinical research presented on April 3 at ACC.16 in Chicago.

The study, conducted by Sreekanth Vemulapalli, MD, et al, analyzed data from the Society of Thoracic Surgery (STS)/ACC Transcatheter Valve Therapy (TVT) Registry to assess the incidence, outcomes, and baseline or procedural factors associated with VHD of transcatheter aortic valve replacement (TAVR )in a real-world setting.

"The STS/ACC TVT Registry provides a unique opportunity to track current TAVR performance in the community," the researchers noted.

The data analyzed included the short-term (1-30 days) and long-term (30 days to one year) cohort results of 22,271 TAVRs performed at 360 sites. The median age of patients in both cohorts was 84. Hypertension was indicated in 89.1 percent of patients in the short-term cohort and 88.2 percent in the long-term cohort. Diabetes mellitus was reported in 35.6 percent of the short-term cohort and 34.9 percent of the long-term cohort. A balloon-expanding valve was used in 79.5 percent of the short-term cohort and 93.9 percent of the long-term cohort.

Retrospective analysis of data using site reported, surveillance echo data obtained at pre-specified time points showed a small but present incidence of VHD after TAVR: 2.1 percent in the short term and 2.5 percent in the long term. VHD and death occurred in 7.1 percent of the short-term cohort and 23.5 percent of the long-term cohort.

The authors noted that VHD does not appear to be associated with excess events. "Cumulative incidence of a composite of death, stroke, myocardial infarction, aortic valve re-intervention and its components are similar between those with and without VHD."

Despite the limitations of the research, including a high level of missing echo data, the data's uncertain relationship to clinical events, and possible underestimation of VHD, the researchers conclude that the results may have a significant impact on patient care. "These findings, especially patient and procedural predictors, may help to inform TAVR care including patient selection, surveillance and preventive strategies," note the authors.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Cardiac Surgery and Arrhythmias

Keywords: Hemodynamics, ACC Annual Scientific Session, Thoracic Surgery, Thoracic Surgical Procedures, Transcatheter Aortic Valve Replacement, STS/ACC TVT Registry, National Cardiovascular Data Registries

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