Transcatheter and Surgical Aortic Valve Replacement in Patients with Recent Acute Heart Failure

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Jalava , M P , Laakso , T , Virtanen , M , Niemelä , M , Ahvenvaara , T , Tauriainen , T , Maaranen , P , Husso , A , Kinnunen , E-M , Dahlbacka , S , Jaakkola , J , Airaksinen , J , Anttila , V , Rosato , S , D’Errigo , P , Savontaus , M , Laine , M , Mäkikallio , T , Valtola , A , Raivio , P , Eskola , M & Biancari , F 2020 , ' Transcatheter and Surgical Aortic Valve Replacement in Patients with Recent Acute Heart Failure ' , Annals of Thoracic Surgery , vol. 109 , no. 1 , pp. 110-117 . https://doi.org/10.1016/j.athoracsur.2019.05.044

Title: Transcatheter and Surgical Aortic Valve Replacement in Patients with Recent Acute Heart Failure
Author: Jalava, Maina P.; Laakso, Teemu; Virtanen, Marko; Niemelä, Matti; Ahvenvaara, Tuomas; Tauriainen, Tuomas; Maaranen, Pasi; Husso, Annastiina; Kinnunen, Eeva-Maija; Dahlbacka, Sebastian; Jaakkola, Jussi; Airaksinen, Juhani; Anttila, Vesa; Rosato, Stefano; D’Errigo, Paola; Savontaus, Mikko; Laine, Mika; Mäkikallio, Timo; Valtola, Antti; Raivio, Peter; Eskola, Markku; Biancari, Fausto
Contributor: University of Helsinki, Clinicum
University of Helsinki, Kardiologian yksikkö
University of Helsinki, Kardiologian yksikkö
University of Helsinki, Kardiologian yksikkö
University of Helsinki, HUS Heart and Lung Center
Date: 2020-01
Language: eng
Number of pages: 8
Belongs to series: Annals of Thoracic Surgery
ISSN: 0003-4975
URI: http://hdl.handle.net/10138/317356
Abstract: Background. Patients with severe aortic stenosis and heart failure have poor prognosis, and their outcomes may be suboptimal even after transcatheter (TAVR) and surgical aortic valve replacement (SAVR). Methods. This is an analysis of the nationwide FinnValve registry, which included patients who underwent primary TAVR or SAVR with a bioprothesis for aortic stenosis. We evaluated the outcome of patients with acute heart failure (AHF) within 60 days prior to TAVR or SAVR. Results. The prevalence of recent AHF was 11.4% (484 of 4241 patients) in the SAVR cohort and 11.3% (210 of 1855 patients) in the TAVR cohort. In the SAVR cohort, AHF was associated with lower 30-day survival (91.3% vs 97.0%; adjusted odds ratio 1.801, 95% confidence interval [CI] 1.125-2.882) and 5-year survival (64.0% vs 81.2%; adjusted hazard ratio 1.482, 95% CI 1.207-1.821). SAVR patients with AHF had higher risk of major bleeding, need of mechanical circulatory support, acute kidney injury, prolonged hospital stay, and composite end-point (30-day mortality, stroke and/or acute kidney injury). Patients with AHF had a trend toward lower 30-day survival (crude rates 95.2% vs 97.9%; adjusted odds ratio 2.028, 95% CI 0.908-4.529) as well as significantly lower 5-year survival (crude rates 45.3% vs 58.5%; adjusted hazard ratio 1.530, 95% CI 1.185-1.976) also after TAVR. AHF increased the risk of acute kidney injury, prolonged hospital stay, and composite end-point after TAVR. Conclusions. Recent AHF is associated with increased risk of mortality and morbidity after SAVR and TAVR. These findings suggest that aortic stenosis patients should be referred for invasive treatment before the development of clinically evident heart failure.
Subject: 3126 Surgery, anesthesiology, intensive care, radiology
Transcatheter aortic valve replacement
TAVR
TAVI
Surgical aortic valve replacement
AVR
Aortic valve stenosis
Acute heart failure
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