Transcatheter versus surgical aortic valve replacement in patients with morbid obesity : a multicentre propensity score-matched analysis
BACKGROUND: Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best therapeutic strategy for these patients remains a matter for debate.
AIMS: Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR.
METHODS: A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities) from 18 centres undergoing either TAVR (n=860) or biological SAVR (n=696) for severe AS was performed. Propensity score matching resulted in 362 pairs.
RESULTS: After matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p<0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p<0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p<0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio [HR] 1.80, 95% confidence interval [CI]: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737).
CONCLUSIONS: SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2022 |
|---|---|
| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:18 |
|---|---|
| Enthalten in: |
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology - 18(2022), 5 vom: 05. Aug., Seite e417-e427 |
| Sprache: |
Englisch |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 08.08.2022 Date Revised 06.08.2023 published: Electronic Citation Status MEDLINE |
|---|
| doi: |
10.4244/EIJ-D-21-00891 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM338522026 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM338522026 | ||
| 003 | DE-627 | ||
| 005 | 20231226000847.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2022 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.4244/EIJ-D-21-00891 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1128.xml |
| 035 | |a (DE-627)NLM338522026 | ||
| 035 | |a (NLM)35321860 | ||
| 035 | |a (PII)EIJ-D-21-00891 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a McInerney, Angela |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Transcatheter versus surgical aortic valve replacement in patients with morbid obesity |b a multicentre propensity score-matched analysis |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 08.08.2022 | ||
| 500 | |a Date Revised 06.08.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: Morbidly obese (MO) patients are increasingly undergoing transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS). However, the best therapeutic strategy for these patients remains a matter for debate | ||
| 520 | |a AIMS: Our aim was to compare the periprocedural and mid-term outcomes in MO patients undergoing TAVR versus SAVR | ||
| 520 | |a METHODS: A multicentre retrospective study including consecutive MO patients (body mass index ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities) from 18 centres undergoing either TAVR (n=860) or biological SAVR (n=696) for severe AS was performed. Propensity score matching resulted in 362 pairs | ||
| 520 | |a RESULTS: After matching, periprocedural complications, including blood transfusion (14.1% versus 48.1%; p<0.001), stage 2-3 acute kidney injury (3.99% versus 10.1%; p=0.002), hospital-acquired pneumonia (1.7% versus 5.8%; p=0.005) and access site infection (1.5% versus 5.5%; p=0.013), were more common in the SAVR group, as was moderate to severe patient-prosthesis mismatch (PPM; 9.9% versus 39.4%; p<0.001). TAVR patients more frequently required permanent pacemaker implantation (14.4% versus 5.6%; p<0.001) and had higher rates of ≥moderate residual aortic regurgitation (3.3% versus 0%; p=0.001). SAVR was an independent predictor of moderate to severe PPM (hazard ratio [HR] 1.80, 95% confidence interval [CI]: 1.25-2.59; p=0.002), while TAVR was not. In-hospital mortality was not different between groups (3.9% for TAVR versus 6.1% for SAVR; p=0.171). Two-year outcomes (including all-cause and cardiovascular mortality, and readmissions) were similar in both groups (log-rank p>0.05 for all comparisons). Predictors of all-cause 2-year mortality differed between the groups; moderate to severe PPM was a predictor following SAVR (HR 1.78, 95% CI: 1.10-2.88; p=0.018) but not following TAVR (p=0.737) | ||
| 520 | |a CONCLUSIONS: SAVR and TAVR offer similar mid-term outcomes in MO patients with severe AS, however, TAVR offers some advantages in terms of periprocedural morbidity | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 700 | 1 | |a Rodés-Cabau, Josep |e verfasserin |4 aut | |
| 700 | 1 | |a Veiga, Gabriela |e verfasserin |4 aut | |
| 700 | 1 | |a López-Otero, Diego |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz-García, Erika |e verfasserin |4 aut | |
| 700 | 1 | |a Campelo-Parada, Francisco |e verfasserin |4 aut | |
| 700 | 1 | |a Oteo, Juan F |e verfasserin |4 aut | |
| 700 | 1 | |a Carnero, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Tafur Soto, José D |e verfasserin |4 aut | |
| 700 | 1 | |a Amat-Santos, Ignacio J |e verfasserin |4 aut | |
| 700 | 1 | |a Travieso, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Mohammadi, Siamak |e verfasserin |4 aut | |
| 700 | 1 | |a Barbanti, Marco |e verfasserin |4 aut | |
| 700 | 1 | |a Cheema, Asim N |e verfasserin |4 aut | |
| 700 | 1 | |a Toggweiler, Stefan |e verfasserin |4 aut | |
| 700 | 1 | |a Saia, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a Dabrowski, Maciej |e verfasserin |4 aut | |
| 700 | 1 | |a Serra, Vicenç |e verfasserin |4 aut | |
| 700 | 1 | |a Alfonso, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Ribeiro, Henrique B |e verfasserin |4 aut | |
| 700 | 1 | |a Regueiro, Ander |e verfasserin |4 aut | |
| 700 | 1 | |a Alpieri, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Gil Ongay, Aritz |e verfasserin |4 aut | |
| 700 | 1 | |a Martinez-Cereijo, Jose M |e verfasserin |4 aut | |
| 700 | 1 | |a Muñoz-García, Antonio |e verfasserin |4 aut | |
| 700 | 1 | |a Matta, Anthony |e verfasserin |4 aut | |
| 700 | 1 | |a Arellano Serrano, Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Barrero, Alejandro |e verfasserin |4 aut | |
| 700 | 1 | |a Tirado-Conte, Gabriela |e verfasserin |4 aut | |
| 700 | 1 | |a Gonzalo, Nieves |e verfasserin |4 aut | |
| 700 | 1 | |a Sanmartin, Xoan C |e verfasserin |4 aut | |
| 700 | 1 | |a de la Torre Hernandez, Jose M |e verfasserin |4 aut | |
| 700 | 1 | |a Kalavrouziotis, Dimitri |e verfasserin |4 aut | |
| 700 | 1 | |a Maroto, Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Forteza-Gil, Alberto |e verfasserin |4 aut | |
| 700 | 1 | |a Cobiella, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Escaned, Javier |e verfasserin |4 aut | |
| 700 | 1 | |a Nombela-Franco, Luis |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology |d 2005 |g 18(2022), 5 vom: 05. Aug., Seite e417-e427 |w (DE-627)NLM185438652 |x 1969-6213 |7 nnns |
| 773 | 1 | 8 | |g volume:18 |g year:2022 |g number:5 |g day:05 |g month:08 |g pages:e417-e427 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.4244/EIJ-D-21-00891 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 18 |j 2022 |e 5 |b 05 |c 08 |h e417-e427 | ||