Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement
Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population. We examined consecutive patients...
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| Veröffentlicht in: | The Journal of invasive cardiology 2021-09, Vol.33 (9), p.E730 |
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| container_issue | 9 |
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| container_title | The Journal of invasive cardiology |
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| creator | Jneid, Hani Farmer, Douglas Kherallah, Riyad Y Paniagua, David Denktas, Ali Kar, Biswajit Cornwell, Lorraine Blaustein, Alvin Preventza, Ourania Jimenez, Ernesto |
| description | Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population.
We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease (CAD), were assessed with multivariable regression and competing-risk analyses.
The 189 consecutive patients enrolled (mean age, 76.6 ± 8.4 years) had a median Society of Thoracic Surgeons (STS) score of 6.0 (interquartile range [IQR], 4.0-8.5). After a maximum follow-up of 7.5 years, 71 (37.6%) deaths occurred, of which 76% had a cardiac cause. Median overall survival was 3.55 years (95% confidence interval [CI], 3.21-5.30); significant graded differences were observed across STS risk subgroups (P |
| doi_str_mv | 10.25270/jic/20.00685 |
| format | Article |
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We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease (CAD), were assessed with multivariable regression and competing-risk analyses.
The 189 consecutive patients enrolled (mean age, 76.6 ± 8.4 years) had a median Society of Thoracic Surgeons (STS) score of 6.0 (interquartile range [IQR], 4.0-8.5). After a maximum follow-up of 7.5 years, 71 (37.6%) deaths occurred, of which 76% had a cardiac cause. Median overall survival was 3.55 years (95% confidence interval [CI], 3.21-5.30); significant graded differences were observed across STS risk subgroups (P<.001). After multivariable adjustment, CAD was significantly associated with cardiac mortality (hazard ratio [HR], 2.6; 95% CI, 1.3-5.3) and all-cause mortality (HR, 2.2; 95% CI, 1.1-4.3). Other independent variables associated with all-cause mortality included age (P=.01), baseline creatinine (P<.01), and chronic obstructive pulmonary disease (P=.03). Baseline ejection fraction (P=.04), age (P<.01), creatinine (P=.02), and vascular disease (P=.04) were independently associated with cardiac-specific mortality.
Long-term survival of veterans after TAVR is comparable to that of their non-veteran counterparts. Significant CAD, along with age and select comorbidities, was associated with poorer survival.</description><identifier>ISSN: 1557-2501</identifier><identifier>EISSN: 1557-2501</identifier><identifier>DOI: 10.25270/jic/20.00685</identifier><identifier>PMID: 34473074</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve - diagnostic imaging ; Aortic Valve - surgery ; Aortic Valve Stenosis - diagnosis ; Aortic Valve Stenosis - surgery ; Humans ; Registries ; Risk Factors ; Transcatheter Aortic Valve Replacement - adverse effects ; Treatment Outcome ; Veterans</subject><ispartof>The Journal of invasive cardiology, 2021-09, Vol.33 (9), p.E730</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><orcidid>0000-0002-4091-1285 ; 0000-0001-6313-7344</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34473074$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jneid, Hani</creatorcontrib><creatorcontrib>Farmer, Douglas</creatorcontrib><creatorcontrib>Kherallah, Riyad Y</creatorcontrib><creatorcontrib>Paniagua, David</creatorcontrib><creatorcontrib>Denktas, Ali</creatorcontrib><creatorcontrib>Kar, Biswajit</creatorcontrib><creatorcontrib>Cornwell, Lorraine</creatorcontrib><creatorcontrib>Blaustein, Alvin</creatorcontrib><creatorcontrib>Preventza, Ourania</creatorcontrib><creatorcontrib>Jimenez, Ernesto</creatorcontrib><title>Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement</title><title>The Journal of invasive cardiology</title><addtitle>J Invasive Cardiol</addtitle><description>Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population.
We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease (CAD), were assessed with multivariable regression and competing-risk analyses.
The 189 consecutive patients enrolled (mean age, 76.6 ± 8.4 years) had a median Society of Thoracic Surgeons (STS) score of 6.0 (interquartile range [IQR], 4.0-8.5). After a maximum follow-up of 7.5 years, 71 (37.6%) deaths occurred, of which 76% had a cardiac cause. Median overall survival was 3.55 years (95% confidence interval [CI], 3.21-5.30); significant graded differences were observed across STS risk subgroups (P<.001). After multivariable adjustment, CAD was significantly associated with cardiac mortality (hazard ratio [HR], 2.6; 95% CI, 1.3-5.3) and all-cause mortality (HR, 2.2; 95% CI, 1.1-4.3). Other independent variables associated with all-cause mortality included age (P=.01), baseline creatinine (P<.01), and chronic obstructive pulmonary disease (P=.03). Baseline ejection fraction (P=.04), age (P<.01), creatinine (P=.02), and vascular disease (P=.04) were independently associated with cardiac-specific mortality.
Long-term survival of veterans after TAVR is comparable to that of their non-veteran counterparts. Significant CAD, along with age and select comorbidities, was associated with poorer survival.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve - diagnostic imaging</subject><subject>Aortic Valve - surgery</subject><subject>Aortic Valve Stenosis - diagnosis</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Humans</subject><subject>Registries</subject><subject>Risk Factors</subject><subject>Transcatheter Aortic Valve Replacement - adverse effects</subject><subject>Treatment Outcome</subject><subject>Veterans</subject><issn>1557-2501</issn><issn>1557-2501</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkDtPwzAUhS0EoqUwsiKPLGn9iO14rCpeUqUiKF0tx7mBVHkU20Hi3xNaQEz36pxPZ_gQuqRkygRTZLat3IyRKSEyE0doTIVQCROEHv_7R-gshC0hjHJNT9GIp6niRKVj9Lzs2tdkDb7Bqz66roGAuxJvIIK3LX60sYI2BjwvhwCvhyw4G9--azzvfKwc3tj6A_AT7GrroBnoc3RS2jrAxc-doJfbm_XiPlmu7h4W82XiWKpjkmXWcuBUS6c1y0DKlABQS1PBRJqVOhdKyoKqvCAyZ05lmrgiV7ngIlOq4BN0fdjd-e69hxBNUwUHdW1b6PpgmBiUaM6IHNDkgDrfheChNDtfNdZ_GkrM3qMZPBpGzN7jwF_9TPd5A8Uf_SuOfwGffG1V</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Jneid, Hani</creator><creator>Farmer, Douglas</creator><creator>Kherallah, Riyad Y</creator><creator>Paniagua, David</creator><creator>Denktas, Ali</creator><creator>Kar, Biswajit</creator><creator>Cornwell, Lorraine</creator><creator>Blaustein, Alvin</creator><creator>Preventza, Ourania</creator><creator>Jimenez, Ernesto</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4091-1285</orcidid><orcidid>https://orcid.org/0000-0001-6313-7344</orcidid></search><sort><creationdate>202109</creationdate><title>Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement</title><author>Jneid, Hani ; Farmer, Douglas ; Kherallah, Riyad Y ; Paniagua, David ; Denktas, Ali ; Kar, Biswajit ; Cornwell, Lorraine ; Blaustein, Alvin ; Preventza, Ourania ; Jimenez, Ernesto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c249t-88aa3e3196c9928e6640ee1a1452548f9b5766d17bd06b2c7890cdb7b535877d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve - diagnostic imaging</topic><topic>Aortic Valve - surgery</topic><topic>Aortic Valve Stenosis - diagnosis</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Humans</topic><topic>Registries</topic><topic>Risk Factors</topic><topic>Transcatheter Aortic Valve Replacement - adverse effects</topic><topic>Treatment Outcome</topic><topic>Veterans</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jneid, Hani</creatorcontrib><creatorcontrib>Farmer, Douglas</creatorcontrib><creatorcontrib>Kherallah, Riyad Y</creatorcontrib><creatorcontrib>Paniagua, David</creatorcontrib><creatorcontrib>Denktas, Ali</creatorcontrib><creatorcontrib>Kar, Biswajit</creatorcontrib><creatorcontrib>Cornwell, Lorraine</creatorcontrib><creatorcontrib>Blaustein, Alvin</creatorcontrib><creatorcontrib>Preventza, Ourania</creatorcontrib><creatorcontrib>Jimenez, Ernesto</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of invasive cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jneid, Hani</au><au>Farmer, Douglas</au><au>Kherallah, Riyad Y</au><au>Paniagua, David</au><au>Denktas, Ali</au><au>Kar, Biswajit</au><au>Cornwell, Lorraine</au><au>Blaustein, Alvin</au><au>Preventza, Ourania</au><au>Jimenez, Ernesto</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement</atitle><jtitle>The Journal of invasive cardiology</jtitle><addtitle>J Invasive Cardiol</addtitle><date>2021-09</date><risdate>2021</risdate><volume>33</volume><issue>9</issue><spage>E730</spage><pages>E730-</pages><issn>1557-2501</issn><eissn>1557-2501</eissn><abstract>Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population.
We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease (CAD), were assessed with multivariable regression and competing-risk analyses.
The 189 consecutive patients enrolled (mean age, 76.6 ± 8.4 years) had a median Society of Thoracic Surgeons (STS) score of 6.0 (interquartile range [IQR], 4.0-8.5). After a maximum follow-up of 7.5 years, 71 (37.6%) deaths occurred, of which 76% had a cardiac cause. Median overall survival was 3.55 years (95% confidence interval [CI], 3.21-5.30); significant graded differences were observed across STS risk subgroups (P<.001). After multivariable adjustment, CAD was significantly associated with cardiac mortality (hazard ratio [HR], 2.6; 95% CI, 1.3-5.3) and all-cause mortality (HR, 2.2; 95% CI, 1.1-4.3). Other independent variables associated with all-cause mortality included age (P=.01), baseline creatinine (P<.01), and chronic obstructive pulmonary disease (P=.03). Baseline ejection fraction (P=.04), age (P<.01), creatinine (P=.02), and vascular disease (P=.04) were independently associated with cardiac-specific mortality.
Long-term survival of veterans after TAVR is comparable to that of their non-veteran counterparts. Significant CAD, along with age and select comorbidities, was associated with poorer survival.</abstract><cop>United States</cop><pmid>34473074</pmid><doi>10.25270/jic/20.00685</doi><orcidid>https://orcid.org/0000-0002-4091-1285</orcidid><orcidid>https://orcid.org/0000-0001-6313-7344</orcidid></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Stenosis - diagnosis Aortic Valve Stenosis - surgery Humans Registries Risk Factors Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome Veterans |
| title | Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement |
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