New adverse coronary events in valve-in-valve TAVR and native TAVR-A 2-year matched cohort

Ofir Koren; Vivek Patel; Robert Naami; Edmund Naami; Takashi Nagasaka; Alon Shechter; Sharon Shalom Natanzon; Siamak Kohan; Zev Allison; Addee Lerner; Daniel Eugene Cheng; Tarun Chakravarty; Mamoo Nakamura; Wen Cheng; Hasan Jilaihawi; Raj R Makkar

doi:10.3389/fcvm.2022.1004103

New adverse coronary events in valve-in-valve TAVR and native TAVR-A 2-year matched cohort

Front Cardiovasc Med. 2022 Sep 21:9:1004103. doi: 10.3389/fcvm.2022.1004103. eCollection 2022.

Authors

Ofir Koren^{1

2}, Vivek Patel¹, Robert Naami³, Edmund Naami⁴, Takashi Nagasaka^{1

5}, Alon Shechter^{1

6}, Sharon Shalom Natanzon¹, Siamak Kohan⁷, Zev Allison¹, Addee Lerner⁸, Daniel Eugene Cheng¹, Tarun Chakravarty¹, Mamoo Nakamura¹, Wen Cheng¹, Hasan Jilaihawi⁹, Raj R Makkar¹

Affiliations

¹ Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States.
² Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel.
³ Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States.
⁴ School of Medicine, University of Illinois, Chicago, IL, United States.
⁵ The Department of Cardiology, Gunma University Hospital, Gunma, Japan.
⁶ Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁷ Internal Medicine, Kaiser Permanente Medical Center, Los Angeles, CA, United States.
⁸ David Geffen School of Medicine, University of California (UCLA), Los Angeles, Los Angeles, CA, United States.
⁹ Heart Valve Center, NYU Langone Health, New York, NY, United States.

Abstract

Objective: To assess the incidence of new adverse coronary events (NACE) following transcatheter aortic valve replacement (TAVR) and valve-in-valve TAVR (ViV-TAVR).

Background: ViV-TAVR is an accepted treatment for degenerative prostheses among patients with high surgical-risk. TAVR studies have suggested an increased risk of coronary artery obstruction and flow stasis causing thrombus formation. Whether contemporary ViV-TAVR is associated with higher rate of coronary events compared to TAVR is unknown.

Methods: We used data from 1,224 TAVR patients between 2016 and 2021. We propensity-matched patients following ViV-TAVR and TAVR by significant predictors to overcome confounders in patients' baseline characteristics and procedural factors.

Results: The matched population included 129 patients in each group. In line with prior reports, there was a higher in-hospital coronary artery obstruction rate with ViV-TAVR (3.1 vs. 1.6%; p = 0.23). Despite this, 2-year cumulative NACE rates were similar between groups (4.7 vs. 6.2%, respectively, p = 0.79), with no difference between its components: myocardial infarction (MI) (p = 0.210), unplanned coronary catheterization (p = 0.477), or coronary artery bypass grafting (CABG) (p = 0.998). Moreover, hypoattenuated leaflets thickening (HALT) at 30-day CT was observed in nearly a quarter of the patients with no difference between groups (23.9 vs. 23.1%, HR 1.02, 95% CI 0.50-1.28, p = 0.872). The progression rate of the coronary artery calcium score (CACS), assessed in a third of patients, was similar between groups (p log-rank = 0.468, 95% CI 0.12-1.24). Low coronary artery height was an unfavorable predictor for in-hospital coronary obstruction and 2-year NACE rate (HR 1.20 and HR 1.25, p = 0.001 and p < 0.0001, respectively).

Conclusion: At 2-year follow-up, ViV-TAVR was not associated with a higher rate of myocardial infarction, unplanned catheterization, coronary artery bypass grafting, or hypoattenuated leaflet thickening.

Keywords: coronary artery bypass graft (CABG); coronary artery calcium score; coronary catheterization; long-term outcome assessment; myocardial infarction; propensity score matching (PSM); transcatheter aortic valve replacement; valve-in-valve.