Universität zu Köln

McElhinney, Doff B., Aboulhosn, Jamil A., Dvir, Danny, Whisenant, Brian, Zhang, Yulin, Eicken, Andreas, Ribichini, Flavio, Tzifa, Aphrodite, Hainstock, Michael R., Martin, Mary H., Kornowski, Ran, Schubert, Stephan, Latib, Azeem ORCID: 0000-0001-9035-343X, Thomson, John D. R., Torres, Alejandro J., Meadows, Jeffery, Delaney, Jeffrey W., Guerrero, Mayra E., Salizzoni, Stefano ORCID: 0000-0002-1032-9155, El-Said, Howaida ORCID: 0000-0002-3447-7398, Finkelstein, Ariel, George, Isaac, Gewillig, Marc, Alvarez-Fuente, Maria, Lamers, Luke, Cheema, Asim N. ORCID: 0000-0002-3174-8957, Kreutzer, Jacqueline N., Rudolph, Tanja, Hildick-Smith, David and Cabalka, Allison K. (2019). Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. J. Am. Coll. Cardiol., 73 (2). S. 148 - 158. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1558-3597

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Abstract

BACKGROUND Transcatheter aortic and pulmonary valves have been used to treat stenosis or regurgitation after prior surgical tricuspid valve (TV) replacement or repair. Little is known about intermediate-term valve-related outcomes after transcatheter tricuspid valve replacement (TTVR), including valve function, thrombus, and endocarditis. OBJECTIVES The authors sought to evaluate mid-term outcomes in a large cohort of patients who underwent TTVR after surgical TV repair or replacement, with a focus on valve-related outcomes. METHODS Patients who underwent TTVR after prior surgical TV replacement or repair were collected through an international registry. Time-related outcomes were modeled and risk factors assessed. RESULTS Data were collected for 306 patients who underwent TTVR from 2008 through 2017 at 80 centers; 52 patients (17%) had a prior history of endocarditis. Patients were followed for a median of 15.9 months after implantation (0.1 to 90 months), with 64% of patients estimated to be alive without TV reintervention or a valve-related event at 3 years. The cumulative 3-year incidence of death, reintervention, and valve-related adverse outcomes (endocarditis, thrombosis, or significant dysfunction) were 17%, 12%, and 8%, respectively. Endocarditis was diagnosed in 8 patients 2 to 29 months after TTVR, for an annualized incidence rate of 1.5% per patient-year (95% confidence interval: 0.45% to 2.5%). An additional 8 patients were diagnosed with clinically relevant valve thrombosis, 3 in the short term, 2 within 2 months, and 3 beyond 6 months. Only 2 of these 8 patients received anticoagulant therapy before thrombus detection (p = 0.13 vs. patients without thrombus). Prior endocarditis was not a risk factor for reintervention, endocarditis, or valve thrombosis, and there was no difference in valve-related outcomes according to TTVR valve type. CONCLUSIONS TV dysfunction, endocarditis, and leaflet thrombosis were uncommon after TTVR. Patients with prior endocarditis were not at higher risk for endocarditis or other adverse outcomes after TTVR, and endocarditis occurred with similar frequency in different valve types. Though rare, leaflet thrombosis is an important adverse outcome, and further study is necessary to determine the appropriate level of prophylactic therapy after TTVR. (J Am Coll Cardiol 2019; 73: 148-57) (c) 2019 by the American College of Cardiology Foundation.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code McElhinney, Doff B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Aboulhosn, Jamil A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Dvir, Danny UNSPECIFIED UNSPECIFIED UNSPECIFIED Whisenant, Brian UNSPECIFIED UNSPECIFIED UNSPECIFIED Zhang, Yulin UNSPECIFIED UNSPECIFIED UNSPECIFIED Eicken, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Ribichini, Flavio UNSPECIFIED UNSPECIFIED UNSPECIFIED Tzifa, Aphrodite UNSPECIFIED UNSPECIFIED UNSPECIFIED Hainstock, Michael R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Martin, Mary H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Kornowski, Ran UNSPECIFIED UNSPECIFIED UNSPECIFIED Schubert, Stephan UNSPECIFIED UNSPECIFIED UNSPECIFIED Latib, Azeem UNSPECIFIED orcid.org/0000-0001-9035-343X UNSPECIFIED Thomson, John D. R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Torres, Alejandro J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Meadows, Jeffery UNSPECIFIED UNSPECIFIED UNSPECIFIED Delaney, Jeffrey W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Guerrero, Mayra E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Salizzoni, Stefano UNSPECIFIED orcid.org/0000-0002-1032-9155 UNSPECIFIED El-Said, Howaida UNSPECIFIED orcid.org/0000-0002-3447-7398 UNSPECIFIED Finkelstein, Ariel UNSPECIFIED UNSPECIFIED UNSPECIFIED George, Isaac UNSPECIFIED UNSPECIFIED UNSPECIFIED Gewillig, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Alvarez-Fuente, Maria UNSPECIFIED UNSPECIFIED UNSPECIFIED Lamers, Luke UNSPECIFIED UNSPECIFIED UNSPECIFIED Cheema, Asim N. UNSPECIFIED orcid.org/0000-0002-3174-8957 UNSPECIFIED Kreutzer, Jacqueline N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rudolph, Tanja UNSPECIFIED UNSPECIFIED UNSPECIFIED Hildick-Smith, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Cabalka, Allison K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-159023
DOI:	10.1016/j.jacc.2018.10.051
Journal or Publication Title:	J. Am. Coll. Cardiol.
Volume:	73
Number:	2
Page Range:	S. 148 - 158
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1558-3597
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language PROSPECTIVE NORTH-AMERICAN; INFECTIVE ENDOCARDITIS; BIOPROSTHETIC VALVES; IMPLANTATION; REGURGITATION; DYSFUNCTION; REPAIR; MODEL Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15902