Long-Term Impact of Cardiac Damage Following Transcatheter Aortic Valve Replacement

Masaaki Nakase; Daijiro Tomii; Dik Heg; Fabien Praz; Stefan Stortecky; David Reineke; Daryoush Samim; Jonas Lanz; Stephan Windecker; Thomas Pilgrim

doi:10.1016/j.jcin.2024.02.011

Long-Term Impact of Cardiac Damage Following Transcatheter Aortic Valve Replacement

JACC Cardiovasc Interv. 2024 Apr 22;17(8):992-1003. doi: 10.1016/j.jcin.2024.02.011.

Authors

Masaaki Nakase¹, Daijiro Tomii², Dik Heg³, Fabien Praz⁴, Stefan Stortecky⁴, David Reineke⁵, Daryoush Samim⁴, Jonas Lanz⁴, Stephan Windecker⁴, Thomas Pilgrim⁶

Affiliations

¹ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/masaaki0825.
² Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: https://twitter.com/DaijiroTomii.
³ Clinical Trials Unit" Bern, University of Bern, Bern, Switzerland.
⁴ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
⁵ Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland.
⁶ Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland. Electronic address: thomas.pilgrim@insel.ch.

PMID: 38658128
DOI: 10.1016/j.jcin.2024.02.011

Abstract

Background: Extravalvular cardiac damage caused by aortic stenosis affects prognosis after transcatheter aortic valve replacement (TAVR). The long-term impact of changes in cardiac damage in response to relief from mechanical obstruction has not been fully investigated.

Objectives: The authors aimed to investigate changes in cardiac damage early after TAVR and the prognostic impact of the cardiac damage classification after TAVR.

Methods: In this single-center observational study, patients undergoing transfemoral TAVR were retrospectively evaluated for cardiac damage before and after TAVR and classified into 5 stages of cardiac damage (0-4).

Results: Among 1,863 patients undergoing TAVR between January 2007 and June 2022, 56 patients (3.0%) were classified as stage 0, 225 (12.1%) as stage 1, 729 (39.1%) as stage 2, 388 (20.8%) as stage 3, and 465 (25.0%) as stage 4. Cardiac stage changed in 47.7% of patients (improved: 30.1% in stages 1-4 and deteriorated: 24.7% in stages 0-3) early after TAVR. Five-year all-cause mortality was associated with cardiac damage both at baseline (HR_adjusted: 1.34; 95% CI: 1.24-1.44; P < 0.001 for linear trend) and after TAVR (HR_adjusted: 1.40; 95% CI: 1.30-1.51; P < 0.001 for linear trend). Five-year all-cause mortality was stratified by changes in cardiac damage (improved, unchanged, or worsened) in patients with cardiac stage 2, 3, and 4 (log-rank P < 0.001 for stage 2, 0.005 for stage 3, and <0.001 for stage 4).

Conclusions: The extent of extra-aortic valve cardiac damage before and after TAVR and changes in cardiac stage early after TAVR have important prognostic implications during long-term follow-up. (SwissTAVI Registry; NCT01368250).

Keywords: aortic stenosis; cardiac damage staging classification; transcatheter aortic valve replacement.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / mortality
Aortic Valve Stenosis* / physiopathology
Aortic Valve Stenosis* / surgery
Aortic Valve* / diagnostic imaging
Aortic Valve* / physiopathology
Aortic Valve* / surgery
Female
Humans
Male
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / mortality
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01368250