Author/Authors :
Makkar، نويسنده , , Raj R. and Jilaihawi، نويسنده , , Hasan and Mack، نويسنده , , Michael and Chakravarty، نويسنده , , Tarun and Cohen، نويسنده , , David J. and Cheng، نويسنده , , Wen and Fontana، نويسنده , , Gregory P. and Bavaria، نويسنده , , Joseph E. and Thourani، نويسنده , , Vinod H. and Herrmann، نويسنده , , Howard C. and Pichard، نويسنده , , Augusto and Kapadia، نويسنده , , Samir and Babaliaros، نويسنده , , Vasilis and Whisenant، نويسنده , , Brian K. and Kodali، نويسنده , , Susheel K. and Williams، نويسنده , , Mathew and Trento، نويسنده , , Alfredo and Smith، نويسنده , , Craig R. and Teirstein، نويسنده , , Paul S. and Cohen، نويسنده , , Mauricio G. and Xu، نويسنده , , Ke and Tuzcu، نويسنده , , E. Murat and Webb، نويسنده , , John G. and Leon، نويسنده , , Martin B.، نويسنده ,
Abstract :
Objectives
al of this study was to examine the impact of reasons for surgical inoperability on outcomes in patients undergoing transcatheter aortic valve replacement (TAVR).
ound
ts with severe aortic stenosis may be deemed inoperable due to technical or clinical reasons. The relative impact of each designation on early and late outcomes after TAVR is unclear.
s
ts were studied from the inoperable arm (cohort B) of the randomized PARTNER (Placement of Aortic Transcatheter Valve) trial and the nonrandomized continued access registry. Patients were classified according to whether they were classified as technically inoperable (TI) or clinically inoperable (CLI). Reasons for TI included porcelain aorta, previous mediastinal radiation, chest wall deformity, and potential for injury to previous bypass graft on sternal re-entry. Reasons for CLI were systemic factors that were deemed to make survival unlikely.
s
369 patients, 23.0% were considered inoperable for technical reasons alone; the remaining were judged to be CLI. For TI, the most common cause was a porcelain aorta (42%); for CLI, it was multiple comorbidities (48%) and frailty (31%). Quality of life and 2-year mortality were significantly better among TI patients compared with CLI patients (mortality 23.3% vs. 43.8%; p < 0.001). Nonetheless, TAVR led to substantial survival benefits compared with standard therapy in both inoperable cohorts.
sions
ts undergoing TAVR based solely on TI have better survival and quality of life improvements than those who are inoperable due to clinical comorbidities. Both TI and CLI TAVR have significant survival benefit in the context of standard therapy. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894)
