Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation: Transcatheter Versus Surgical Aortic Valve Replacement

Dongfeng Zhang, Wei Guo, Mohammed A. Al-Hijji, Abdallah El Sabbagh, Bradley R. Lewis, Kevin Greason, Gurpreet S Sandhu, Mackram Eleid, David Holmes, Joerg Herrmann

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)e012110
JournalJournal of the American Heart Association
Volume8
Issue number10
DOIs
StatePublished - May 21 2019

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Aortic Valve Stenosis
Aortic Valve
Surgical Instruments
Thorax
Radiation
Atrial Fibrillation
Mortality
Radiotherapy
Peripheral Arterial Disease
Kaplan-Meier Estimate
Transcatheter Aortic Valve Replacement
Lung Diseases
Length of Stay
Hospitalization
Chronic Disease
Heart Failure
Population

Keywords

  • aortic valve implantation
  • aortic valve stenosis
  • radiation
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation : Transcatheter Versus Surgical Aortic Valve Replacement. / Zhang, Dongfeng; Guo, Wei; Al-Hijji, Mohammed A.; El Sabbagh, Abdallah; Lewis, Bradley R.; Greason, Kevin; Sandhu, Gurpreet S; Eleid, Mackram; Holmes, David; Herrmann, Joerg.

In: Journal of the American Heart Association, Vol. 8, No. 10, 21.05.2019, p. e012110.

Research output: Contribution to journalArticle

Zhang, Dongfeng ; Guo, Wei ; Al-Hijji, Mohammed A. ; El Sabbagh, Abdallah ; Lewis, Bradley R. ; Greason, Kevin ; Sandhu, Gurpreet S ; Eleid, Mackram ; Holmes, David ; Herrmann, Joerg. / Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation : Transcatheter Versus Surgical Aortic Valve Replacement. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 10. pp. e012110.
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abstract = "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.",
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author = "Dongfeng Zhang and Wei Guo and Al-Hijji, {Mohammed A.} and {El Sabbagh}, Abdallah and Lewis, {Bradley R.} and Kevin Greason and Sandhu, {Gurpreet S} and Mackram Eleid and David Holmes and Joerg Herrmann",
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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

AU - Holmes, David

AU - Herrmann, Joerg

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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