TY - JOUR
T1 - Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation
T2 - Transcatheter Versus Surgical Aortic Valve Replacement
AU - Zhang, Dongfeng
AU - Guo, Wei
AU - Al-Hijji, Mohammed A.
AU - El Sabbagh, Abdallah
AU - Lewis, Bradley R.
AU - Greason, Kevin
AU - Sandhu, Gurpreet S.
AU - Eleid, Mackram F.
AU - Holmes, David R.
AU - Herrmann, Joerg
N1 - Funding Information:
This study was supported by research funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (HL116952 to Herrmann) and National Cancer Institute (1 RO1 CA233610‐01 to Herrmann) and the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Funding Information:
This study was supported by research funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (HL116952 to Herrmann) and National Cancer Institute (1 RO1 CA233610-01 to Herrmann) and the Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN. The Mayo Clinic STS (Society of Thoracic Surgery) and TVT (Transcatheter Valve Therapy) registries were screened for patients who underwent TAVR or SAVR for severe AS and had a history of chest radiation for malignancy (total number of patients screened from February 2011 to April 2018, n=1210 for TAVR and n=1707 for SAVR). The Mayo Clinic Institutional Review Board approved this study as well as a waiver of the requirement to obtain informed consent in accordance with 45 CFR 46.116 and a waiver of HIPAA authorization in accordance with applicable HIPAA regulations. The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure unless approved by all authors after review and conclusion of a reasonable request.
Publisher Copyright:
© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2019/5/21
Y1 - 2019/5/21
N2 - Background: Patients with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort. It is unknown how transcatheter aortic valve replacement (TAVR) compares with surgical aortic valve replacement in this group of patients, which was the objective of this study. Methods and Results: We retrospectively reviewed all patients with severe aortic stenosis who underwent either TAVR or surgical aortic valve replacement at our institution with a history of mediastinal radiation (n=55 per group). End points were echocardiographic and clinical outcomes in-hospital, at 30 days, and at 1 year. Inverse propensity weighting analysis was used to account for intergroup baseline differences. TAVR patients had a higher STS score than surgical aortic valve replacement patients (5.1% [3.2, 7.7] versus 1.6% [0.8, 2.6], P<0.001) and more often (P<0.01 for all) a history of atrial fibrillation (45.5% versus 12.7%), chronic lung disease (47.3% versus 7.3%), peripheral arterial disease (38.2% versus 7.3%), heart failure (58.2% versus 18.2%), and pacemaker therapy (23.6% versus 1.8%). Postoperative atrial fibrillation was less frequent (1.8% versus 27.3%; P<0.001) and hospital stay was shorter in TAVR patients (4.0 [2.0, 5.0] versus 6.0 [5.0, 8.0] days; P<0.001). The ratio of observed-to-expected 30-day mortality was lower after TAVR as was 30-day mortality in inverse propensity weighting–adjusted Kaplan–Meier analyses. Conclusions: In patients with severe aortic stenosis and a history of chest radiation therapy, TAVR performs better than predicted along with less adjusted 30-day all-cause mortality, postoperative atrial fibrillation, and shorter hospitalization compared with surgical aortic valve replacement. These data support further studies on the preferred role of TAVR in this unique patient population.
AB - Background: Patients with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort. It is unknown how transcatheter aortic valve replacement (TAVR) compares with surgical aortic valve replacement in this group of patients, which was the objective of this study. Methods and Results: We retrospectively reviewed all patients with severe aortic stenosis who underwent either TAVR or surgical aortic valve replacement at our institution with a history of mediastinal radiation (n=55 per group). End points were echocardiographic and clinical outcomes in-hospital, at 30 days, and at 1 year. Inverse propensity weighting analysis was used to account for intergroup baseline differences. TAVR patients had a higher STS score than surgical aortic valve replacement patients (5.1% [3.2, 7.7] versus 1.6% [0.8, 2.6], P<0.001) and more often (P<0.01 for all) a history of atrial fibrillation (45.5% versus 12.7%), chronic lung disease (47.3% versus 7.3%), peripheral arterial disease (38.2% versus 7.3%), heart failure (58.2% versus 18.2%), and pacemaker therapy (23.6% versus 1.8%). Postoperative atrial fibrillation was less frequent (1.8% versus 27.3%; P<0.001) and hospital stay was shorter in TAVR patients (4.0 [2.0, 5.0] versus 6.0 [5.0, 8.0] days; P<0.001). The ratio of observed-to-expected 30-day mortality was lower after TAVR as was 30-day mortality in inverse propensity weighting–adjusted Kaplan–Meier analyses. Conclusions: In patients with severe aortic stenosis and a history of chest radiation therapy, TAVR performs better than predicted along with less adjusted 30-day all-cause mortality, postoperative atrial fibrillation, and shorter hospitalization compared with surgical aortic valve replacement. These data support further studies on the preferred role of TAVR in this unique patient population.
KW - aortic valve implantation
KW - aortic valve stenosis
KW - radiation
KW - transcatheter aortic valve implantation
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U2 - 10.1161/JAHA.119.012110
DO - 10.1161/JAHA.119.012110
M3 - Article
C2 - 31124737
AN - SCOPUS:85066833307
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
SN - 2047-9980
IS - 10
M1 - e012110
ER -