TY - JOUR
T1 - Anticoagulation After Surgical or Transcatheter Bioprosthetic Aortic Valve Replacement
AU - Chakravarty, Tarun
AU - Patel, Akshar
AU - Kapadia, Samir
AU - Raschpichler, Matthias
AU - Smalling, Richard W.
AU - Szeto, Wilson Y.
AU - Abramowitz, Yigal
AU - Cheng, Wen
AU - Douglas, Pamela S.
AU - Hahn, Rebecca T.
AU - Herrmann, Howard C.
AU - Kereiakes, Dean
AU - Svensson, Lars
AU - Yoon, Sung Han
AU - Babaliaros, Vasilis C.
AU - Kodali, Susheel
AU - Thourani, Vinod H.
AU - Alu, Maria C.
AU - Liu, Yangbo
AU - McAndrew, Thomas
AU - Mack, Michael
AU - Leon, Martin B.
AU - Makkar, Raj R.
N1 - Funding Information:
The PARTNER 2 Trial was funded by Edwards Lifesciences. Dr. Chakravarty has been a proctor and consultant for Edwards Lifesciences and Medtronic. Dr. Szeto has received grant support from Edwards Lifesicences and Metronic; and has served as a consultant for MicroInterventional Devices. Dr. Douglas has core lab contracts with Edwards Lifesciences. Dr. Hahn has core lab contracts with Edwards Lifesciences. Dr. Herrmann has received grant support from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and has served as a consultant for Edwards Lifesciences. Dr. Kereiakes has served as a consultant for Boston Scientific, Abbott Vascular, and REVA Medical Inc. Dr. Svensson has served as an unpaid member of the PARTNER Trial Executive Committee (Edwards Lifesciences); holds equity in Cardiosolutions and ValvXchange; and holds intellectual property rights for Posthorax. Dr. Babaliaros has served as a consultant for Edwards Lifesciences and Abbott Vascular. Dr. Kodali has served as a consultant for Abbott Vascular, Merrill Lifesciences, and Claret Medical; and has served on the Scientific Advisory Boards of Thubrikar Aortic Valve, Inc., Dura Biotech, and Biotrace Medical. Dr. Thourani has served on the Advisory Boards of Abbott Vascular, Gore Vascular, Bard Medical, JenaValve, and Boston Scientific. Dr. Mack has served as an unpaid member of the PARTNER Trial Executive Committee (Edwards Lifesciences). Dr. Leon has served as an unpaid member of the PARTNER Trial Executive Committee (Edwards Lifesciences). Dr. Makkar has received grant support from Edwards Lifesciences and St. Jude Medical; and has served as a consultant for Abbott Vascular, Cordis, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2019
PY - 2019/9/3
Y1 - 2019/9/3
N2 - Background: There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes. Objectives: The study aimed to assess the impact of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes. Methods: Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively. Results: A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 0.17; 95% confidence interval [CI]: 0.05–0.60; p = 0.006). Conclusions: In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined.
AB - Background: There is paucity of evidence on the impact of anticoagulation (AC) after bioprosthetic aortic valve replacement (AVR) on valve hemodynamics and clinical outcomes. Objectives: The study aimed to assess the impact of AC after bioprosthetic AVR on valve hemodynamics and clinical outcomes. Methods: Data on antiplatelet and antithrombotic therapy were collected. Echocardiograms were performed at 30 days and 1 year post-AVR. Linear regression model and propensity-score adjusted cox proportional model were used to assess the impact of AC on valve hemodynamics and clinical outcomes, respectively. Results: A total of 4,832 patients undergoing bioprosthetic AVR (transcatheter aortic valve replacement [TAVR], n = 3,889 and surgical AVR [SAVR], n = 943) in the pooled cohort of PARTNER2 (Placement of Aortic Transcatheter Valves) randomized trials and nonrandomized registries were studied. Following adjustment for valve size, annular diameter, atrial fibrillation, and ejection fraction at the time of assessment of hemodynamics, there was no significant difference in aortic valve mean gradients or aortic valve areas between patients discharged on AC vs. those not discharged on AC, for either TAVR or SAVR cohorts. A significantly greater proportion of patients not discharged on AC had an increase in mean gradient >10 mm Hg from 30 days to 1 year, compared with those discharged on AC (2.3% vs. 1.1%, p = 0.03). There was no independent association between AC after TAVR and adverse outcomes (death, p = 0.15; rehospitalization, p = 0.16), whereas AC after SAVR was associated with significantly fewer strokes (hazard ratio [HR]: 0.17; 95% confidence interval [CI]: 0.05–0.60; p = 0.006). Conclusions: In the short term, early AC after bioprosthetic AVR did not result in adverse clinical events, did not significantly affect aortic valve hemodynamics (aortic valve gradients or area), and was associated with decreased rates of stroke after SAVR (but not after TAVR). Whether early AC after bioprosthetic AVR has impact on long-term outcomes remains to be determined.
KW - anticoagulation
KW - bioprosthetic aortic valve replacement
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85070936757&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2019.06.058
DO - 10.1016/j.jacc.2019.06.058
M3 - Article
C2 - 31466616
AN - SCOPUS:85070936757
VL - 74
SP - 1190
EP - 1200
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 9
ER -