Abstract
Objectives The goal of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Background Patients with severe aortic stenosis may be deemed inoperable due to technical or clinical reasons. The relative impact of each designation on early and late outcomes after TAVR is unclear. Methods Patients were studied from the inoperable arm (cohort B) of the randomized PARTNER (Placement of Aortic Transcatheter Valve) trial and the nonrandomized continued access registry. Patients were classified according to whether they were classified as technically inoperable (TI) or clinically inoperable (CLI). Reasons for TI included porcelain aorta, previous mediastinal radiation, chest wall deformity, and potential for injury to previous bypass graft on sternal re-entry. Reasons for CLI were systemic factors that were deemed to make survival unlikely. Results Of the 369 patients, 23.0% were considered inoperable for technical reasons alone; the remaining were judged to be CLI. For TI, the most common cause was a porcelain aorta (42%); for CLI, it was multiple comorbidities (48%) and frailty (31%). Quality of life and 2-year mortality were significantly better among TI patients compared with CLI patients (mortality 23.3% vs. 43.8%; p < 0.001). Nonetheless, TAVR led to substantial survival benefits compared with standard therapy in both inoperable cohorts. Conclusions Patients undergoing TAVR based solely on TI have better survival and quality of life improvements than those who are inoperable due to clinical comorbidities. Both TI and CLI TAVR have significant survival benefit in the context of standard therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
| Original language | English |
|---|---|
| Pages (from-to) | 901-911 |
| Number of pages | 11 |
| Journal | Journal of the American College of Cardiology |
| Volume | 63 |
| Issue number | 9 |
| DOIs | |
| State | Published - Mar 11 2014 |
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Keywords
- inoperable
- risk
- TAVI
- TAVR
- transcatheter aortic valve
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Stratification of outcomes after transcatheter aortic valve replacement according to surgical inoperability for technical versus clinical reasons. / Makkar, Raj R.; Jilaihawi, Hasan; Mack, Michael; Chakravarty, Tarun; Cohen, David J.; Cheng, Wen; Fontana, Gregory P.; Bavaria, Joseph E.; Thourani, Vinod H.; Herrmann, Howard C.; Pichard, Augusto; Kapadia, Samir; Babaliaros, Vasilis; Whisenant, Brian K.; Kodali, Susheel K.; Williams, Mathew; Trento, Alfredo; Smith, Craig R.; Teirstein, Paul S.; Cohen, Mauricio G; Xu, Ke; Tuzcu, E. Murat; Webb, John G.; Leon, Martin B.
In: Journal of the American College of Cardiology, Vol. 63, No. 9, 11.03.2014, p. 901-911.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Stratification of outcomes after transcatheter aortic valve replacement according to surgical inoperability for technical versus clinical reasons
AU - Makkar, Raj R.
AU - Jilaihawi, Hasan
AU - Mack, Michael
AU - Chakravarty, Tarun
AU - Cohen, David J.
AU - Cheng, Wen
AU - Fontana, Gregory P.
AU - Bavaria, Joseph E.
AU - Thourani, Vinod H.
AU - Herrmann, Howard C.
AU - Pichard, Augusto
AU - Kapadia, Samir
AU - Babaliaros, Vasilis
AU - Whisenant, Brian K.
AU - Kodali, Susheel K.
AU - Williams, Mathew
AU - Trento, Alfredo
AU - Smith, Craig R.
AU - Teirstein, Paul S.
AU - Cohen, Mauricio G
AU - Xu, Ke
AU - Tuzcu, E. Murat
AU - Webb, John G.
AU - Leon, Martin B.
PY - 2014/3/11
Y1 - 2014/3/11
N2 - Objectives The goal of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Background Patients with severe aortic stenosis may be deemed inoperable due to technical or clinical reasons. The relative impact of each designation on early and late outcomes after TAVR is unclear. Methods Patients were studied from the inoperable arm (cohort B) of the randomized PARTNER (Placement of Aortic Transcatheter Valve) trial and the nonrandomized continued access registry. Patients were classified according to whether they were classified as technically inoperable (TI) or clinically inoperable (CLI). Reasons for TI included porcelain aorta, previous mediastinal radiation, chest wall deformity, and potential for injury to previous bypass graft on sternal re-entry. Reasons for CLI were systemic factors that were deemed to make survival unlikely. Results Of the 369 patients, 23.0% were considered inoperable for technical reasons alone; the remaining were judged to be CLI. For TI, the most common cause was a porcelain aorta (42%); for CLI, it was multiple comorbidities (48%) and frailty (31%). Quality of life and 2-year mortality were significantly better among TI patients compared with CLI patients (mortality 23.3% vs. 43.8%; p < 0.001). Nonetheless, TAVR led to substantial survival benefits compared with standard therapy in both inoperable cohorts. Conclusions Patients undergoing TAVR based solely on TI have better survival and quality of life improvements than those who are inoperable due to clinical comorbidities. Both TI and CLI TAVR have significant survival benefit in the context of standard therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
AB - Objectives The goal of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). Background Patients with severe aortic stenosis may be deemed inoperable due to technical or clinical reasons. The relative impact of each designation on early and late outcomes after TAVR is unclear. Methods Patients were studied from the inoperable arm (cohort B) of the randomized PARTNER (Placement of Aortic Transcatheter Valve) trial and the nonrandomized continued access registry. Patients were classified according to whether they were classified as technically inoperable (TI) or clinically inoperable (CLI). Reasons for TI included porcelain aorta, previous mediastinal radiation, chest wall deformity, and potential for injury to previous bypass graft on sternal re-entry. Reasons for CLI were systemic factors that were deemed to make survival unlikely. Results Of the 369 patients, 23.0% were considered inoperable for technical reasons alone; the remaining were judged to be CLI. For TI, the most common cause was a porcelain aorta (42%); for CLI, it was multiple comorbidities (48%) and frailty (31%). Quality of life and 2-year mortality were significantly better among TI patients compared with CLI patients (mortality 23.3% vs. 43.8%; p < 0.001). Nonetheless, TAVR led to substantial survival benefits compared with standard therapy in both inoperable cohorts. Conclusions Patients undergoing TAVR based solely on TI have better survival and quality of life improvements than those who are inoperable due to clinical comorbidities. Both TI and CLI TAVR have significant survival benefit in the context of standard therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
KW - inoperable
KW - risk
KW - TAVI
KW - TAVR
KW - transcatheter aortic valve
UR - http://www.scopus.com/inward/record.url?scp=84895511122&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84895511122&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.08.1641
DO - 10.1016/j.jacc.2013.08.1641
M3 - Article
VL - 63
SP - 901
EP - 911
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 9
ER -