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Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study

Bleiziffer, S; Bosmans, J; Brecker, S; Gerckens, U; Wenaweser, P; Tamburino, C; Linke, A (2017) Insights on mid-term TAVR performance: 3-year clinical and echocardiographic results from the CoreValve ADVANCE study. Clinical Research in Cardiology, 106 (10). pp. 784-795. ISSN 1861-0692 https://doi.org/10.1007/s00392-017-1120-3
SGUL Authors: Brecker, Stephen

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Abstract

Background Extensive evidence relating to transcatheter aortic valve replacement (TAVR) has accumulated in recent years, but mid-term outcomes are less reported. We investigated 996 patients after implantation of the CoreValve prosthesis for severe aortic stenosis in a real-world setting. Objective To report clinical and echocardiographic 3-year results from the ADVANCE study. Methods ADVANCE is a prospective, multicenter, fully monitored, nonrandomized clinical study. This analysis assessed valve-related events, predictors of early and mid-term mortality after TAVR, and systolic and diastolic prosthesis performance over 3 years. Results Three years after TAVR, the rate of major adverse cardiac/cerebrovascular events was 38.5%. All-cause mortality was 33.7%; cardiovascular mortality, 22.3%; cVARC-1 stroke, 6.5%; and New York Heart Association class III/IV, 19.5%. Mean effective orifice area was consistently 1.7 cm2 from discharge to 3 years, and average mean aortic valve gradient remained ≤10 mmHg. At 3 years, 12.6% of patients had moderate and none had severe paravalvular regurgitation. Multivariable analysis identified Society of Thoracic Surgeons (STS) score, device migration, prior atrial fibrillation, and major vascular complication as predictors of early mortality. Predictors of mid-term mortality included male gender, STS score, history of chronic obstructive pulmonary disease, history of cancer, stroke, life-threatening/disabling or major bleeding, and valve deterioration. Conclusions Our 3-year data demonstrate significant hemodynamic benefits and durable symptom relief after CoreValve prosthesis implantation. Postprocedural patient management should be carefully considered since postprocedural valve-related events were identified as independent predictors of mid-term mortality.

Item Type: Article
Additional Information: The final publication is available at Springer via http://doi.org/10.1007/s00392-017-1120-3 Erratum available at http://dx.doi.org/10.1007/s00392-017-1124-z or via SORA at http://openaccess.sgul.ac.uk/109078/
Keywords: Cardiovascular System & Hematology, 1102 Cardiovascular Medicine And Haematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Clinical Research in Cardiology
ISSN: 1861-0692
Dates:
DateEvent
October 2017Published
8 May 2017Published Online
25 April 2017Accepted
Publisher License: Publisher's own licence
URI: https://openaccess.sgul.ac.uk/id/eprint/108801
Publisher's version: https://doi.org/10.1007/s00392-017-1120-3

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