Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation

Hikaru Tsuruta, Kentaro Hayashida, Fumiaki Yashima, Ryo Yanagisawa, Makoto Tanaka, Takahide Arai, Yugo Minakata, Yuji Itabashi, Mitsushige Murata, Shun Kosaka, Yuichiro Maekawa, Tatsuo Takahashi, Akihiro Yoshitake, Hideyuki Shimizu, Keiichi Fukuda

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Objectives: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. Methods: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient >30 mm Hg. Results: Over 1 year of follow-up after TAVI, 21 patients (13.3%) demonstrated postprocedural LVO. The incidence was highest at 3-months follow-up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2%) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8%) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.30-0.67; P<0.001), transvalvular velocity (OR, 2.44; 95% CI, 1.13-5.26; P=0.023), and the presence of accelerated intraventricular flow at baseline (OR, 6.13; 95% CI, 1.49-25.2; P=0.012) were associated with the occurrence of LVO. Postprocedural LVO was not associated with midterm all-cause death or heart failure events. Conclusion: In patients who underwent TAVI, MVO occurred more often than LVOT obstruction. However, the occurrence of postprocedural LVO was not associated with worsened clinical outcomes in these patients.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
DOIs
Publication statusAccepted/In press - 2018 Jan 1

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Incidence
Odds Ratio
Confidence Intervals
Aortic Valve Stenosis
Transcatheter Aortic Valve Replacement
Cause of Death
Multivariate Analysis
Heart Failure
Pressure

Keywords

  • Aortic valve stenosis
  • Echocardiography
  • Transcatheter aortic valve replacement
  • Ventricular outflow obstruction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation. / Tsuruta, Hikaru; Hayashida, Kentaro; Yashima, Fumiaki; Yanagisawa, Ryo; Tanaka, Makoto; Arai, Takahide; Minakata, Yugo; Itabashi, Yuji; Murata, Mitsushige; Kosaka, Shun; Maekawa, Yuichiro; Takahashi, Tatsuo; Yoshitake, Akihiro; Shimizu, Hideyuki; Fukuda, Keiichi.

In: Catheterization and Cardiovascular Interventions, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Objectives: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. Methods: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient >30 mm Hg. Results: Over 1 year of follow-up after TAVI, 21 patients (13.3{\%}) demonstrated postprocedural LVO. The incidence was highest at 3-months follow-up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2{\%}) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8{\%}) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95{\%} confidence interval [CI], 0.30-0.67; P<0.001), transvalvular velocity (OR, 2.44; 95{\%} CI, 1.13-5.26; P=0.023), and the presence of accelerated intraventricular flow at baseline (OR, 6.13; 95{\%} CI, 1.49-25.2; P=0.012) were associated with the occurrence of LVO. Postprocedural LVO was not associated with midterm all-cause death or heart failure events. Conclusion: In patients who underwent TAVI, MVO occurred more often than LVOT obstruction. However, the occurrence of postprocedural LVO was not associated with worsened clinical outcomes in these patients.",
keywords = "Aortic valve stenosis, Echocardiography, Transcatheter aortic valve replacement, Ventricular outflow obstruction",
author = "Hikaru Tsuruta and Kentaro Hayashida and Fumiaki Yashima and Ryo Yanagisawa and Makoto Tanaka and Takahide Arai and Yugo Minakata and Yuji Itabashi and Mitsushige Murata and Shun Kosaka and Yuichiro Maekawa and Tatsuo Takahashi and Akihiro Yoshitake and Hideyuki Shimizu and Keiichi Fukuda",
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T1 - Incidence, predictors, and midterm clinical outcomes of left ventricular obstruction after transcatheter aortic valve implantation

AU - Tsuruta, Hikaru

AU - Hayashida, Kentaro

AU - Yashima, Fumiaki

AU - Yanagisawa, Ryo

AU - Tanaka, Makoto

AU - Arai, Takahide

AU - Minakata, Yugo

AU - Itabashi, Yuji

AU - Murata, Mitsushige

AU - Kosaka, Shun

AU - Maekawa, Yuichiro

AU - Takahashi, Tatsuo

AU - Yoshitake, Akihiro

AU - Shimizu, Hideyuki

AU - Fukuda, Keiichi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objectives: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. Methods: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient >30 mm Hg. Results: Over 1 year of follow-up after TAVI, 21 patients (13.3%) demonstrated postprocedural LVO. The incidence was highest at 3-months follow-up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2%) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8%) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.30-0.67; P<0.001), transvalvular velocity (OR, 2.44; 95% CI, 1.13-5.26; P=0.023), and the presence of accelerated intraventricular flow at baseline (OR, 6.13; 95% CI, 1.49-25.2; P=0.012) were associated with the occurrence of LVO. Postprocedural LVO was not associated with midterm all-cause death or heart failure events. Conclusion: In patients who underwent TAVI, MVO occurred more often than LVOT obstruction. However, the occurrence of postprocedural LVO was not associated with worsened clinical outcomes in these patients.

AB - Objectives: We aimed to evaluate the incidence and midterm clinical outcomes of left ventricular obstruction (LVO) after transcatheter aortic valve implantation (TAVI). Backgrounds: LVO is occasionally unmasked following valve replacement for severe aortic stenosis. However, little is known about the prevalence and effects of LVO after TAVI. Methods: A total of 158 patients who underwent TAVI in our center between October 2013 and November 2015 received echocardiographic evaluations at baseline; before hospital discharge; and at 3, 6, and 12 months after TAVI. LVO was defined as a peak pressure gradient >30 mm Hg. Results: Over 1 year of follow-up after TAVI, 21 patients (13.3%) demonstrated postprocedural LVO. The incidence was highest at 3-months follow-up and decreased at 6 months or later. Of the 21 patients with LVO, 20 (95.2%) demonstrated midventricular obstruction (MVO), whereas only 1 (4.8%) showed obstruction of the outflow tract (LVOT) with systolic anterior motion (SAM) of the mitral leaflet. In a multivariate analysis, the LVOT diameter (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.30-0.67; P<0.001), transvalvular velocity (OR, 2.44; 95% CI, 1.13-5.26; P=0.023), and the presence of accelerated intraventricular flow at baseline (OR, 6.13; 95% CI, 1.49-25.2; P=0.012) were associated with the occurrence of LVO. Postprocedural LVO was not associated with midterm all-cause death or heart failure events. Conclusion: In patients who underwent TAVI, MVO occurred more often than LVOT obstruction. However, the occurrence of postprocedural LVO was not associated with worsened clinical outcomes in these patients.

KW - Aortic valve stenosis

KW - Echocardiography

KW - Transcatheter aortic valve replacement

KW - Ventricular outflow obstruction

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