EFFECT OF VALVE TYPE ON OUTCOMES OF TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH SEVERE PULMONARY HYPERTENSION: A RETROSPECTIVE COMPARATIVE COHORT STUDY

Abstract

TOPIC: Cardiovascular Disease TYPE: Original Investigations PURPOSE: A previous study showed that Transcatheter Aortic Valve Replacement (TAVR) is associated with less major adverse cardiovascular events (MACE) than surgical repair in patients with severe pulmonary hypertension (PH). However, it is still unknown whether MACE complicating TAVR is valve independent or not. We aimed to compare the incidence of MACE between two common types of valves in TAVR, Edwards SAPIEN (Edwards Lifesciences LLC, Irvine, CA) and Medtronic CoreValve (MCV). METHODS: We conducted a retrospective cohort study utilizing Jersey Shore University Medical Center Cath Lab database for the years 2012-2020. We identified patients with PH using invasive hemodynamic measurements. MACE were defined as death, myocardial infarction, stroke, hospitalization due to heart failure, or coronary revascularization. We compared the incidence of MACE up to 1 year of follow up. The study protocol was reviewed and approved by Hackensack Meridian Institutional Review Board. An alpha cutoff of 0.05 was used to ascertain statistical significance. RESULTS: We identified a total of 84 patients with severe PH who underwent TAVR (28 received MCV, 56 received SAPIEN). Baseline characteristics, including age, gender, male, race, white, type of Insurance, prior coronary artery bypass graft surgery, prior percutaneous coronary intervention, presence of implantable cardioverter defibrillator device, prior aortic valve repair, prior stroke or transient ischemic attack, prior carotid artery stenosis, peripheral arterial disease, smoking, hypertension, diabetes mellitus, end stage renal disease, chronic lung diseases were comparable between the two study groups. Fourteen percent of the patients who received MCV developed MACE (n=4), as opposed to 11% in patients who received SAPIEN (n=6); however, the difference was not statistically significant (p=0.9). Even after adjusting for the aforementioned baseline characteristics in a multivariable logistic regression model (enter method), type of valve was not independently associated with incidence of MACE. CONCLUSIONS: There is no difference in the incidence of MACE between different types of valves in patients with severe PH undergoing TAVR. CLINICAL IMPLICATIONS: Both Edwards Sapiens and Medtronic CoreValve are equally safe in patients with severe pulmonary hypertension undergoing transcatheter aortic valve replacement. DISCLOSURES: No relevant relationships by Firas Ajam, source=Web Response No relevant relationships by Abbas Alshami, source=Web Response No relevant relationships by Renato Apolito, source=Web Response No relevant relationships by Steven Douedi, source=Web Response No relevant relationships by Daniel Kiss, source=Web Response No relevant relationships by Aref Obagi, source=Web Response No relevant relationships by Matthew Saybolt, source=Web Response No relevant relationships by Vandan Upadhyaya, source=Web Response