14 Feb TAVR: Factors Associated With Valve Hemodynamic Deterioration Identified

MedicalResearch.com Interview with:

Dr. Rodés-Cabau

Josep Rodés-Cabau, MD
Director, Catheterization and Interventional Laboratories
Quebec Heart and Lung Institute
Professor, Faculty of Medicine, Laval University
Quebec City, Quebec, Canada

Medical Research: What is the background for this study? What are the main findings?

Response: Several concerns have recently emerged regarding valve thrombosis post-TAVR. It has been also proposed that rapid changes in transvalvular gradients may be the hallmark of valve thrombosis despite of the absence of clinical symptoms. However, no data exist on the incidence of and factors associated with valve hemodynamic deterioration (VHD) following TAVR.

We included 1,521 patients who underwent TAVR in 10 centers worldwide. VHD was defined as an absolute change in mean transvalvular gradient during follow-up ≥10 mm Hg compared with discharge assessment. Incidence of  valve hemodynamic deterioration was 4.5% during a mean echocardiographic FU of 20 months (2.8% within the first year). We found that the lack of anticoagulation therapy, a valve-in-valve procedure (TAVR in a surgical valve), a greater BMI, and the use of a 23mm transcatheter valve were the factors associated with higher rates of VHD post-TAVR. Also, the absence of anticoagulant therapy remained as an independent predictor of VHD in a sub-analysis excluding patients with small valves, valve-in-valve procedure, and aortic regurgitation at discharge ≥moderate. We think these results suggest a thrombotic mechanism as one of the factors underlying VHD.

Medical Research: What should clinicians and patients take away from your report?

Response: The occurrence of subclinical valve hemodynamic degeneration within the year following TAVR was not associated with poorer clinical outcomes at a mean clinical follow-up of >2 years. However, we think that despite the lack of major clinical consequences, physicians may consider a closer clinical and echocardiographic follow-up in patients at higher risk of valve deterioration. In addition, anticoagulation therapy should be recommended in those patients diagnosed of valve hemodynamic deterioration before any further intervention.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: We think that future studies should evaluate the impact of early valve hemodynamic deterioration post-TAVR on long-term valve durability and clinical outcomes. In this regard, subclinical changes in mean transaortic gradient after TAVR should be included at least as a secondary endpoint in future trials evaluating transcatheter valve therapies

In the same way, prospective randomized trials are required to identify if a specific antithrombotic regimen post-TAVR may reduce the risk of incident valve hemodynamic deterioration.

Citation:

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Dr. Josep Rodés-Cabau (2016). TAVR: Factors Associated With Valve Hemodynamic Deterioration Identified

Last Updated on February 14, 2016 by Marie Benz MD FAAD