Post Transcatheter Aortic Valve Replacement Research Articles

Abstract 14229: Utilization of Calcium Scores to Predict TAVR Outcomes in Paradoxical Severe Aortic Stenosis

Introduction: In patients with severe symptomatic (Stage D) aortic stenosis (AS), the disease is subcategorized based on the gradient, flow and left ventricular ejection fraction (LVEF). Stage D3 reflects low-flow, low-gradient severe AS with normal LVEF (paradoxical low-flow severe AS [PLFLG AS]. Current guidelines suggest measurement of a Computed Tomography (CT) derived calcium score of the native valve is helpful for management. Furthermore, calcium score can provide prognostic information for transcatheter aortic valve replacement (TAVR) in the general AS population. However, whether CT-derived calcium scores can predict major adverse cardiovascular events (MACE) in PLFLG AS patients undergoing TAVR has not been examined. Methods: We retrospectively investigated post-TAVR outcomes at 1 year, in patients echocardiographically characterized as PLFLG AS at our center between Jan. 2017 and Dec. 2020. Continuous variables were assessed for normality using the Kolmogorov-Smirnov test, histogram, and Q-Q plot. Logistic regression models were used to assess if calcium scores were associated with outcomes, and statistical significance was assumed if p<0.05. Results: : A total of 85 patients were included in the analysis. The baseline pre- and immediately post TAVR data are described in Table 1. In our cohort, 16 had MACE (18.8%) at 1 year. Calcium score as a predictor of MACE (odds ratio (OR): 0.99; p=0.93), death (OR: 0.99; p=0.79), stroke (OR 1.01; p=0.90), myocardial infarction (OR 0.97; p=0.63), and post-TAVR paravalvular aortic regurgitation (OR 1.02; p=0.47) did not reach statistical significance. Conclusions: In our cohort, CT-derived calcium scores did not predict MACE events or post-TAVR paravalvular aortic regurgitation in PLFLG AS. The study had several limitations: it is a single center retrospective study with a small sample size, potentially leading to recording bias.

Abstract 14838: Prevalence and Outcomes of Prosthetic Valve Endocarditis Post-Tavr: A Proportion Meta-Analysis

Introduction: Prosthetic valve endocarditis (PVE) may occur after trans-catheter aortic valve replacement (TAVR), resulting in bio-prosthetic valve dysfunction. We aim to assess the clinical characteristics and long-term outcomes post TAVR. Methods: We performed a systematic literature search in PubMed, Scopus, and Embase for relevant articles from inception until June 01, 2022. Primary outcome was all-cause mortality. Secondary outcomes include acute kidney injury, stroke, systemic embolisation, heart failure and valve re-intervention. All endpoints were pooled using a random-effect model. Results: A total of 33 studies were included, comprising 346,094 patients who underwent TAVR. Amongst the various co-morbidities, most common were diabetes (11%), chronic kidney disease (8%) and chronic obstructive pulmonary disease (COPD) (8%).The pooled incidence of PVE was 1% [95% CI (1%-2%)]. The most common approach was trans-femoral (n=15) (88% [95% CI (79%-95%)]) followed by trans-apical (n=9) (14% [95% CI(10%-18%)]). The most common organisms isolated were staphylococcus species (n=24) (34% [95% CI (30%-38%)]), followed by streptococcal species (n=23) in 23% and enterococcus species (n=22) in 24%. The leading complications reported were acute kidney injury (AKI) (30% [95% CI (19%-44%)]) (n=7), cerebrovascular accident (10% [95% CI (7%-14%)]) (n=13), embolisation (17% [95% CI (10%-26%)]) (n=11) and patients requiring a surgical valve replacement (12% [95% CI (8%-18%)] ) (n=14). The all-cause mortality was 49% [95% CI (41%-56%)], while the in-hospital mortality was 4% [95% CI (2%-9%)]. Conclusions: Incidence of IE post TAVR is low (1%), but is associated with a higher rate of mortality (49%) and morbidity. As a result, aggressive management is needed to reduce post-TAVR complications.

Abstract 14439: Using Augmented Mean Arterial Pressure to Assess Post-Transcatheter Aortic Valve Replacement Mortality

Introduction: Post-transcatheter aortic valve replacement (TAVR) outcome of patients is an important research topic. To accurately assess post-TAVR mortality, we examined a family of new echo-parameters (augmented systolic blood pressure (AugSBP) and arterial mean pressure parameters (AugMAP)) derived from blood pressure and aortic valve gradient ( Figure 1 ). Methods: Patients in the Mayo Clinic National Cardiovascular Diseases Registry-TAVR database who underwent TAVR between January 1, 2012, and June 30, 2017, were identified to retrieve baseline clinical, echocardiographic, and mortality data. The median of AugSBP and AugMAP were used to stratify patients in Kaplan-Meier analysis. Results: The final cohort contained 974 patients with a mean age of 81.4±8.3 years old, and 56.6% were male. The mean Society of Thoracic Surgeons risk score was 8.2±5.2. The median follow-up duration was 354 days, and the one-year all-cause mortality rate was 14.2%. Detailed characteristics are summarized in Table 1. AugMAP1 < 102.5 mmHg (median) was associated with a 3-fold risk of all-cause mortality post-TAVR at 1 year (hazard ratio 3.0, 95%confidence interval 2.0-4.5, p<0.0001)( Figure 1 ). Conclusions: Augmented mean arterial pressure provides clinicians with a simple but effective approach to quickly identify patients at risk and potentially improve post-TAVR prognosis.

Abstract 14904: Post-Tavr 30-Day and 90-Day Readmission for Acute Coronary Syndrome - Insight From the National Readmission Database

Background: Post-transcatheter aortic valve replacement readmissions are increasingly the major focus of quality improvement efforts. Limited data exist about patient post-TAVR readmitted for acute coronary syndrome (ACS). Methods: The National Readmission Sample was queried from 2011-2017 for relevant ICD-9 and ICD-10 codes to identify patients who underwent TAVR who presented with ACS as primary diagnosis after indexed admission for TAVR. We identified 30-day and 90-day readmission rate, characteristics, mortality and in-hospital outcomes. Results: A total of 104,920 patients underwent TAVR. We identified 623 (0.6%) patients with primary diagnosis of ACS post-TAVR. From the patients who presented with ACS, 31% (n=193) and 41% (n=256) occurred within 30 days and 90 days of TAVR, respectively. Within 30-day and 90-day readmission for ACS post-TAVR, average age was 80.2 years and 80.3 years with 66.7% and 61.1% being male, respectively. Baseline characteristics are highlighted on Table 1. Mortality in patients post-TAVR who were readmitted in 30 days and 90 days for ACS was 14.8% and 9.3%, respectively. Conclusions: Although readmissions after TAVR in patients with ACS is relatively low (0.6%), they are associated with higher in-hospital mortality rate than the general population who present with ACS (~7 to 8%) and pose a higher health care burden.

Cardiac arrhythmias and conduction disorders monitoring after transcatheter aortic valve replacement procedure, using a mobile electrocardiogram 6 lead device

Abstract Background In the early post transcatheter aortic valve replacement (TAVR) discharge era, rate of readmission for permanent pacemaker implantation (PPM-I) due to delayed conduction disturbances (CDs) has significantly increased. This issue has powered post procedural ambulatory electrocardiogram (AECG) monitoring by using implantable cardiac monitors or mobile cardiac telemetry devices, despite several disadvantages as frequent electrode changes and costs. Purpose In this scenario we aimed to evaluate the incidence of post-TAVR new onset arrhythmias and delayed CDs, performing an AECG monitoring through a 30s spot digital ECG (AeECG), by using a mobile electrocardiogram 6 lead (ME6L) device in a 30 days period after a TAVR procedure. Methods Between March 2021 and February 2022 we consecutively enrolled all patients undergoing a TAVR at the University Hospital of Pisa, excepting who already had a PM. At discharge, all patients received ME6L device and were asked to record a spot eECG for 1 month: 1 eECG per day during the first week and then 1 eECG per week. Clinical and follow-up data were collected and analyzed, and eECG scheduling compliance and quality recordings were explored. Results Among 185 consecutive TAVR patients, 12 were excluded due to pre-existing pacing device and 33 due to PPM-I <2 days post TAVR; 3 died before enrollment and 10 refused the enrollment; 18 were excluded because failed the ME6L training phase, 6 for severe postprocedural complications and the last 3 because affected by isolated aortic regurgitation.The remaining ones (100) had 30-day AeECG data. Delayed CDs with a Class I/IIa indications for PPM-Ioccurred in 8 patients with a median of 6 days (range 4–8 days) post-TAVR. New onset documented arrhythmias were AT/AF in 3 patients, isolated PVCs in 10 patients, and competitive transitory junctional rhythm in 2 patients. Delayed PPM-I versus non-delayed PPM-Ipatients were more likely to have a non-self-expandable valve (3 vs 69; p=0.02) and longer PR and QRS intervals at discharge (250.00±53,29 ms vs 179.17±39.17 ms; p=0,003; 125±33.38 ms vs 102.55±30.48 ms; p=0,04). The overall eECG schedule level compliance was 96.5%. Out of a total of 965 sent eECGs, 950 (98,4%) have been correctly recorded and transmitted. Conclusion Delayed CDs requiring PPM-I are the most important drawback of TAVR procedure. In our study, AeECG was seen to be safe and helpful in the identification and treatment of delayed CDs requiring PPM-I, with a very high eECG schedule level of compliance and quality. Further prospective studies are needed to better identify patient selection for outpatient monitoring, making safer and safer the early post TAVR discharge approach. Funding Acknowledgement Type of funding sources: None.

Electrocardiographic changes after TAVR and their clinical impact according to new ESC Pacing Guidelines

Abstract Conduction disturbances after transcatheter aortic valve replacement (TAVR) remain one of the most frequent complications. The aim of this study was to analyze ECG changes after TAVR using contemporary valves and to detect risk factors for the need of further clinical evaluation according to new ESC pacing guidelines to evaluate pacemaker implantation. In this retrospective analysis we included 850 patients (mean age 80±9 years, 51% female), who underwent TAVR in our institution from January 2019 until December 2020. A mean follow-up of 8.9±8.4 months and 217 (25.5%) patients was performed. 55% of the implanted valves were self-expandable, 45% balloon-expandable. After TAVR, 77 (9.1%) patients developed new LBBB and QRS >150ms, 26 (3.1%) new PR-time >240ms. Prolongation of PR-time and prolongation of QRS duration >20ms were seen in 20 (2.4%) and 90 (10.6%) patients with preexisting conduction disturbances. 152 (17.9%) patients needed pacemaker implantation post TAVR. Developing a PR-prolongation of >20ms was associated with calcification of the annulus (OR 1.2 CI 95% 1.004–1.4; p=0.04). New LBBB (OR 0.45; CI 95% 0.25–0.79; p=0.006) and pacemaker implantation (OR 0.4; CI 95% 0.2–0.8; p=0.009) were correlated with the implantation of a self-expandable valve. Coronary heart disease (OR 3, CI 95% 1.07–8.2; p=0.04) and peripheral arterial disease (OR 2.6 CI 95% 1.18–5.6; p=0.02) were associated with prolongation of QRS >20ms. New LBBB with QRS >150ms was seen more often after post-dilatation (OR 1.03, CI 95% 1.01–1.05; p=0.05). Pre-existing AV block I° (OR 2.8, CI 95% 1.4–5.6; p<0.001), pre-existing RBBB (OR 20.5, CI 95% 7.5–56; p<0.001), nicotine abuse (OR 2, CI 95% 1.05–3.8; p=0.04), prosthesis oversizing (OR 1.06, CI 95% 1.006–1.11; p=0.03) and implantation depth (OR 1.13, CI 95% 1.006–1.26; p=0.04) were independent risk factors for pacemaker implantation. During the follow-up 161 patients (18.9%) were hospitalized in 270 inpatient stays [cardiac decompensation (n=36, 13%), pacemaker implantation (n=9, 3.3%), acute coronary syndrome (n=12, 4.4%)]. 8 patients (80%) received a pacemaker implantation because of AV Block III° and 1 (10%) patient because of sick-sinus-syndrome (SSS). Analyzing the post TAVR ECG 5 (50%) had a new LBBB (3 (30%) with QRS >150ms) and 4 (40%) patients showed LBBB together with AV Block I°. According to new guidelines 213 (25.1%) patients would have needed further clinical evaluation (EP study or ECG monitoring) after TAVR. AV-conduction abnormalities were associated with annulus calcification. Self-expandable valves were associated with new LBBB and pacemaker implantation. There seems to be a correlation between arteriosclerotic diseases and QRS width post TAVR. Pre-existing RBBB, AV block I°, implantation depth and prosthesis oversizing are important risk factors for pacemaker implantation post TAVR. New LBBB after TAVR is associated with a higher risk for pacemaker implantation in the long-term analysis. Funding Acknowledgement Type of funding sources: None.

Immediately improved LA function demonstrated with pulmonic vein Doppler-intraoperative TEE in TAVR patients

Abstract Background Recent studies exhibited the immediately improved left atrium (LA) function by Doppler mitral inflow and mitral annular velocity by tissue Doppler and left atrial appendage flow velocity. This study aims to investigate the improvement of LA function by pulmonic vein Doppler parameters performing by an intraoperative transesophageal echocardiogram (TEE) during transcatheter aortic valve replacement (TAVR). Material and methods Patients who underwent TAVR from January 2020 to September 2021 and pulmonic vein Doppler were acquired by TEE (right upper pulmonic vein from 90–110° mid-esophageal view) during TAVR with the explicit image. We obtained S-, D-, A-wave velocity; LV end-diastolic pressure (LVEDP) and mean pressure gradient across aortic valve (mean-AVPG) from invasive catheter both pre-TAVR and immediate post-TAVR. All parameters between pre-TAVR and post-TAVR were compared with paired t-test. Results 38 patients (mean age 79.7±5.6 years, 17 female) were enrolled in this study. S-wave was only significant parameter with increased velocity from baseline (30.3±24.6 cm/s vs 50.2±23.2 cm/s, p<0.001), whereas D-wave and A-wave were not significantly changed from baseline (35.1±15.2 cm/s vs 33.7±11.0 cm/s, p=0.6; and 14.3±8.6 cm/s vs 13.0±8.9 cm/s, p=0.4, respectively). LVEDP was not significantly changed from baseline (19.6±9.5 mmHg vs 18.7±8.1 mmHg, p=0.49) but mean-AVPG was significantly decreased after TAVR (53.8±11.8 mmHg vs 6.1±5.6 mmHg, p<0.001). We also noted 25 patients who had S/D ratio <1 at baseline, 19 of 25 patients were changed to S/D ratio >1 immediately post TAVR. Conclusion This study demonstrated the improved LA function with pulmonic vein Doppler after TAVR. S-wave is the only parameter to be improvement immediately post TAVR and change to S/D ratio >1 in majority of patients. Funding Acknowledgement Type of funding sources: None.

Comparing direct oral anticoagulants versus vitamin K antagonist in patients with atrial fibrillation after transcatheter aortic valve replacement: an updated meta-analysis

Abstract Background Oral anticoagulation therapy is indicated for patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant or new onset atrial fibrillation (AF). However the data on optimal anticoagulation regimen in this population remains unclear. Purpose To compare efficacy and safety outcomes of direct oral anticoagulants (DOACs) versus Vitamin K antagonists (VKA) in patients with AF post TAVR. Methods We searched electronic databases (PubMed, Embase, Scopus, Cochrane) from inception to February28th, 2022 using MeSH terms and keywords for DOACs, AF or TAVR. Primary outcome of interest was all-cause stroke or systemic embolic event. Secondary safety outcomes were major bleeding and all-cause mortality. Pooled risk ratio (RR) and 95% confidence interval (CI) were calculated using a random-effects model. Interstudy heterogeneity was assessed using the Higgins I 2 value. All statistical analysis were performed using RevMan 5.4.1 software. Results We identified five eligible studies (1RCT, 4 observational) including 3694 patients (DOAC n=1581, VKA n=2113). The mean age was 81.4±0.9 years. The mean follow-up was 12.4±14.3 months. Type of DOACs included apixaban (n=394, 24.9%), rivaroxaban (n=354, 22.4%), dabigatran (n=119, 7.5%) and edoxaban (n=714, 45.2%).There was no significant difference in primary outcome of stroke or systemic embolic event (RR: 0.93; CI: 0.65–1.33; p>0.05; I2=5%), or in secondary outcomes of major bleeding (RR: 1.02; CI: 0.78–1.34; p>0.05; I2=44%) and all-cause mortality (RR: 0.87; CI: 0.59–1.27; p>0.05; I2=56%) between DOACs and VKA groups. Conclusion This meta-analysis shows anticoagulation therapy with DOACs has similar safety and efficacy outcomes compared to VKA in patients with AF undergoing TAVR. Funding Acknowledgement Type of funding sources: None.

LONG-TERM ORAL SUPPRESSIVE ANTIBIOTIC THERAPY FOR PROSTHETIC VALVE ENDOCARDITIS WITH PERIVALVULAR EXTENSION

LONG-TERM ORAL SUPPRESSIVE ANTIBIOTIC THERAPY FOR PROSTHETIC VALVE ENDOCARDITIS WITH PERIVALVULAR EXTENSION

Incidence, Timing, and Causes of Late Bleeding After TAVR in an Asian Cohort.

Data regarding the incidence, predictive factors, and clinical outcomes of post-transcatheter aortic valve replacement (TAVR) bleeding is limited in the Asian cohort. This study sought to assess the predictors and prognostic impact of post-TAVR late bleeding. This study used the Japanese multicenter registry data to analyze 2,518 patients (mean age: 84.3 ± 5.2 years) who underwent TAVR. Late bleeding was defined as any postdischarge bleeding events after TAVR. Baseline characteristics, predictive factors, and clinical outcomes including death and rehospitalization were assessed in patients with and without late bleeding events. The cumulative incidence rate of all and major late bleeding and ischemic stroke were 7.4%, 5.2%, and 3.4%, respectively, 3 years after TAVR. The independent predictive factors of late bleeding were low platelet count, high score (≥4) on the clinical frailty scale, and a New York Heart Association functional class III/IV. The cumulative mortality rates up to 3 years were significantly higher in patients with late bleeding than in those without bleeding (P< 0.001). The multivariate Cox regression analysis revealed that late bleeding, included as a time-varying covariate in the model, was associated with an increased risk of mortality following TAVR (HR: 5.63; 95%CI: 4.28-7.41; P< 0.001). Late bleeding after TAVR was not a rare complication, and it significantly increased long-term mortality. It should be carefully managed, especially when it is predictable in the high-risk cohort, and efforts should be taken to reduce bleeding complications even after a successful procedure.

Transvalvular Pressure Gradients andAll-Cause Mortality Following TAVR: AMulticenter Echocardiographic and Invasive Registry.

Low ejection fraction (EF) and low flow as determined by an echocardiographic stroke volume index(SVi)<35mL/m2 are associated with low transvalvular gradients and increased mortality in both severe aorticstenosis (AS) and post-transcatheter aortic valve replacement (TAVR). Absence of an elevated echocardiographic transaorticgradient post-TAVR is considered a marker of procedural success despite the absence of data on its impactonmortality. The authors sought to examine the association of invasive and echocardiographic gradients post-TAVR with all-cause mortality in relation to flow and EF. In a multicenter retrospective registry of patients undergoing TAVR, Cox models with regression splines explored the relationship between invasive and echocardiographic gradients post-TAVR with 2-year mortality. An invasive gradient<5mmHg was considered low, between≥5 and<10mmHg was considered intermediate, and≥10mmHg was considered high. An echocardiographic gradient<10mmHg was considered low,≥10 and<20mmHg was considered intermediate, and≥20mmHg was considered high. Higher mortality occurred in low echocardiographic gradients at discharge relative to intermediate gradients (P< 0.001), and low gradient was associated with lower EF and echocardiographic SVi (P< 0.001 and P< 0.008, respectively). Lower mortality occurred in low invasive gradients relative to intermediate gradients (P=0.012) with no difference in EF and echocardiographic SVi between groups (P = 0.089 and P=0.947, respectively). There were insufficient observations to determine the impact of high echocardiographic and invasive gradients on mortality. In this large retrospective analysis, the impact of transaortic gradients on mortality after TAVR wasnot linear and complex, showing opposite results among echocardiographic and invasive measurements in low-gradient patients.

When should early discharge post-transcatheter aortic valve replacement be blocked?

When should early discharge post-transcatheter aortic valve replacement be blocked?

Costs and outcomes of mobile cardiac outpatient telemetry monitoring post-transcatheter aortic valve replacement.

Aim: To estimate the costs and outcomes of transcatheter aortic valve replacement (TAVR) recipients based on the use of mobile cardiac outpatient telemetry (MCOT) monitoring. Materials & methods: A retrospective database study was conducted to estimate costs, contribution margins (CMs), pacemaker insertions and other outcomes for patients undergoing TAVR procedures with MCOT monitoring post-procedure versus non-MCOT monitoring. Results: A total of 4164 patients were identified (283 MCOT monitoring and 3881 non-MCOT monitoring). The rate of pacemaker insertion following hospital discharge was higher in the MCOT cohort (6.6MCOT vs 2.1% non-MCOT; p=0.007). MCOT use was associated with lower costs and improved CMs of the index TAVR admission (costs: US$40,569 MCOT vs $43,289 non-MCOT; p=0.003; CMs: US$7087 MCOT vs $5177 non-MCOT; p=0.047) with no difference through the subsequent 60-day period following discharge. Conclusion: MCOT for ambulatory cardiac monitoring post-TAVR discharge is associated with higher rates of pacemaker insertion, at no overall greater costs.

Association of preprocedural ultrashort-term heart rate variability with clinical outcomes after transcatheter aortic valve replacement: A nested, case-control, pilot study.

ABSTRACTBackground:Because heart rate variability (HRV) has been linked to important clinical outcomes in various cardiovascular disease states, we investigated whether preprocedural ultrashort-term HRV (UST-HRV) differs between 1-year survivors and nonsurvivors after transcatheter aortic valve replacement (TAVR).Methods:In our single-center, retrospective, nested pilot study, we analyzed data from patients with severe aortic stenosis undergoing TAVR. All patients had preprocedural UST-HRV measured before the administration of any medications or any intervention. To investigate whether preprocedural HRV is associated with 1-year survival, we performed a logistic regression analysis controlling for Kansas City Cardiomyopathy Questionnaire 12 score.Results:In our parent cohort of 100 patients, 42 patients (28 survivors and 14 nonsurvivors) were included for analysis. Root mean square of successive differences (RMSSD) and standard deviation of NN intervals (SDNN) were lower in patients who survived to 1-year post TAVR compared to nonsurvivors [10 (IQR 8–23) vs 23 (IQR 17–33), P = 0.04 and 10 (IQR 7–16) vs 17 (IQR 11–40), P = 0.03, respectively]. Logistic regression demonstrated a trend in the association of preprocedure RMSSD with 1-year mortality and a 5% higher risk of 1-year mortality with each unit increment in UST-HRV using SDNN (OR 1.05; 95%CI 1.01–1.09, P = 0.02).Conclusion:Our data suggest an inverse relationship between preprocedural UST-HRV and 1-year survival post-TAVR. This finding highlights the potential complexity of HRV regulation in chronic vs acute illness. Prospective studies are needed to validate our findings and to determine whether UST-HRV can be used for risk stratification in patients with severe aortic stenosis.

Transcatheter aortic valve replacement with anterograde guide wire through atrial septum in 2 patients with severe aortic stenosis post transcatheter or surgical aortic valve replacement

经股动脉逆行导丝跨瓣是目前经导管主动脉瓣置换术中最常见的跨瓣方法。该文报道2例主动脉瓣置换术后瓣膜衰败的重度主动脉瓣狭窄患者，导丝逆行跨主动脉瓣难度大，采用穿刺房间隔顺行跨瓣方法成功建立轨道，人工瓣膜经股动脉逆行释放，避免顺行释放可能造成的二尖瓣损伤。术后超声心动图提示人工瓣膜流速、跨瓣压差明显改善，无明显瓣周漏，患者症状明显改善，短期临床效果满意。穿刺房间隔顺行跨瓣对于导丝跨瓣难度大的经导管主动脉瓣置换术患者是一种有效的替代方法。.

Comparison of 26-mm Evolut and 23-mm Sapien 3 Valves in TAVR for Small Aortic Annulus.

Patients with small aortic annuli (SAA) are prone to higher post-transcatheter aortic valve replacement (TAVR) transvalvular gradients and development of prosthesis-patient mismatch (PPM). In many patients with SAA, the choice of TAVR valve commonly involves choosing between the 26-mm Medtronic Evolut 2 (ME26) or the 23-mm Edwards Sapien 3 valve (ES23). We compared echocardiographic and clinical outcomes in patients with SAA undergoing TAVR with either valve. We queried the Providence St. Joseph Health Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry database for patients undergoing TAVR with either the ES23 or ME26 between July 2015 and December 2018 at 11 hospitals. Post-TAVR echocardiographic and clinical results in-hospital, at 1 month, and at 1 year were examined. High gradient (HG) was defined as mean gradient (MG) ≥20 mm Hg. We identified 1162 patients with SAA undergoing TAVR with either the ME26 (n = 233) or ES23 valve (n = 929). Baseline characteristics between groups were similar. At 1 month, the ME26 was associated with a lower MG than the ES23 (7.7 ± 4.7 mm Hg vs 13.1 ± 4.9 mm Hg; P<.001) and moderate or severe PPM (11% and 3% vs 27% and 13%; P<.001). Occurrence of HG at 1 year was lower with the ME26 valve vs the ES23 valve (0% vs 15%; P<.001). In-hospital and follow-up clinical outcomes to 1 year were similar for both groups. TAVR in SAA with the ME26 is associated with lower incidence of HG or PPM compared with the ES23. While clinical outcomes at 1 year were similar, the long-term implications of these findings remain unknown.

Abstract 87: Comparative Outcomes Of TAVR In African Americans Versus Non-African Americans

Introduction: African Americans (AA) experience more postoperative complications compared to non-African Americans (NAA) after certain procedures. Few studies compare clinical outcomes between AA and NAA post Transcatheter Aortic Valve Replacement (TAVR). Our aim is to further explore racial disparities among TAVR patients. Methods: Retrospective analysis of electronic medical records from March 2018-November 2020 of a major academic center and affiliated Veterans Affairs hospital in Chicago, IL identified all TAVR patients. Participants self-identified by race and were stratified into AA and NAA groups. The primary outcome was 3-point composite major adverse cardiac outcomes (MACE) (all cause death, myocardial infarction, cerebrovascular accident). Secondary outcomes included major differences in comorbidities, creatinine, baseline mean gradient, congestive heart failure (CHF) exacerbations, and hospital admissions. Outcomes were analyzed at 6- and 12-months post TAVR. Results: We included 151 patients in the analysis; 22% female, 65% were non-AA (44.7% white, 16.4% Hispanic, and 3.9% other) and 35% AA. They were 74 +/- 14 years old for the AA and 74 +/- 10 years old for non-AA. At 6 months (AA:15.1% v NAA:8.1%; p=.2) and at 12 months (AA:22.6% v NAA:16.2%; p=.3), there was no difference in MACE between the two populations. At 6 months post TAVR, AA were more likely to have a CHF exacerbation compared to NAA (AA:15.1% v NAA:3.1%; p=.007) despite a similar prevalence of heart failure at baseline, hypertension, hyperlipidemia, diabetes, coronary artery disease, atrial fibrillation and smoking. AA were found to have a higher baseline mean gradient when compared to NAA (AA: 36.2 v NAA:31.9 mmHg; p=.049). Creatinine at time of procedure was higher in AA when compared to NAA (Cr: 2.37 vs. 1.49 mg/dL; p=.015) and AA trended towards higher rates of end stage renal disease compared to NAA (AA:22.6% v NAA:11.1%; p=.059). Conclusion: We observed significant disparities between AA and their NAA counterparts. While both groups had similar rates of composite MACE events post TAVR at 6 and 12 months, AA tend to be a higher risk post-operative population. AA were more likely to have CHF exacerbations and were evaluated for TAVR at a later stage in their disease course.

Abstract 79: The Impact Of Left Atrial And Left Ventricular Size On TAVR Outcomes

Introduction: In severe aortic stenosis, left atrium (LA) and left ventricle (LV) enlargement are common physiologic sequelae but their prognostic value in transcatheter aortic valve replacement (TAVR) outcomes is still being investigated. The purpose of this study is to look at the effect of left atrial and ventricular size on major adverse cardiac events (MACE) following TAVR. Methods: Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois at Chicago and affiliated Veterans Affairs identified TAVR patients. The cutoff for normal LA diameter was &lt;4.0 cm. Normal LV systolic diameter was &lt;4.1 cm and an enlarged LV based on dilated systolic LV diameter. Primary outcomes included composite MACE (all-cause mortality, myocardial infarction, or cerebrovascular accident) at 6- and 12- months post TAVR. MACE was then stratified based on the number of dilated left-sided chambers. Results: We included 134 patients in the analysis. The study population was 81% (109 of 134) male, 56% (75 of 134) non-white, and 74 ± 12 years old. Patients that experienced MACE at 6 months were found to have a larger systolic LV diameter (3.9 vs 3.3 cm, p=0.02). MACE was stratified based on the number of dilated chambers (neither, LA or LV, both) and was found to be significant at 6 months (4.1% to 10.4% and 35.3% p=0.002) but not at 12 months (12.2% vs 19.1% vs 35.3% p=0.11). Patients with increased LA size (4.8 vs. 4.1 cm; p=0.001) had higher rates of MACE, specifically with respect to mortality (p=0.007). When comparing patients with an enlarged LA (4.8 cm) to normal-sized LA (&lt;4.0 cm), there was no statistically significant difference in ejection fraction &lt;50% (16.7% vs 14.5% of patients, respectively; p=0.8) or enlarged diastolic LV diameter (4.5 vs. 4.6 cm; p=0.7). Conclusion: Our results suggest that patients with an enlarged LA or LV may have an increased risk for mortality and composite MACE following procedure at either 6- or 12-months even when controlling for confounding factors such as depressed LV or enlarged diastolic LV diameter. Our study suggests LA and LV size should be considered in risk stratifying patients prior to TAVR.

C-51 | Predictors of Cardiogenic Shock in Patients Post-Transcatheter Aortic Valve Replacement

C-51 | Predictors of Cardiogenic Shock in Patients Post-Transcatheter Aortic Valve Replacement

A retrospective study on the trends in surgical aortic valve replacement outcomes in the post-transcatheter aortic valve replacement era.

Background and AimsTranscatheter aortic valve replacement (TAVR) is the mainstay of treatment of inoperable and severe high‐risk aortic stenosis and is noninferior to surgical aortic valve replacement (SAVR) for low‐risk and intermediate‐risk patients as well. We aim to compare the valve size, area, and transaortic mean gradients in SAVR patients before and after the implementation of TAVR since being approved by the Food and Drug Administration in 2011.MethodsPatients who underwent a bioprosthetic SAVR placement were divided into two groups based on the date of procedure: the early pre‐TAVR implementation group (years 2011–2012) and the contemporary post‐TAVR group (years 2019–2020). The primary endpoint was the mean gradient across the aortic valve within 16 months of surgery. The secondary endpoints included the difference in valve size and various aortic valve echocardiographic variables.ResultsOne hundred and thirty patients had their valves replaced in the years 2011–2012 and 134 in the years 2019–2020. The early group had a significantly higher mean gradient (median of 13 mmHg [interquartile range, IQR: 9.3–18] vs. 10 mmHg [IQR: 7.5–13.1], p = 0.001) and a smaller median effective orifice area index (0.8 cm2/m2 [IQR: 0.6–1] vs. 1.1 cm2/m2 [IQR: 0.8–1.3], p < 0.001). The median valve size was significantly smaller in the early group (median of 21 mm [IQR: 21–23] vs. 23 mm [IQR: 22.5–25], p < 0.001).ConclusionIn the contemporary era, surgical patients receive larger valves which translates into lower mean gradients, larger valve area, and lower rates of patient‐prosthesis mismatch than in previous years before the routine introduction of TAVR.