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Original research
Transcatheter aortic valve implantation in patients with rheumatic aortic stenosis
  1. Taishi Okuno1,
  2. Daijiro Tomii1,
  3. Eric Buffle1,
  4. Jonas Lanz1,
  5. Christoph Ryffel1,
  6. Caglayan Demirel1,
  7. Suliman Hashemi1,
  8. Daniel Hagemeyer1,
  9. Athanasios Papadis1,
  10. Dik Heg2,
  11. Fabien Praz1,
  12. Stefan Stortecky1,
  13. Stephan Windecker1,
  14. Thomas Pilgrim1
  1. 1Cardiology, Inselspital, University of Bern, Bern, Switzerland
  2. 2CTU Bern, University of Bern, Bern, Switzerland
  1. Correspondence to Dr Thomas Pilgrim, Department of Cardiology, University of Bern, Bern, Switzerland; Thomas.pilgrim{at}insel.ch

Abstract

Background Rheumatic heart disease (RHD) accounts for the highest number of deaths from valvular heart disease globally. Yet, rheumatic aortic stenosis (AS) was excluded from landmark studies investigating the safety and efficacy of transcatheter aortic valve implantation (TAVI). We aimed to describe the clinical and anatomical characteristics of patients with rheumatic AS undergoing TAVI, and to compare procedural and clinical outcomes with patients undergoing TAVI for degenerative AS.

Methods In a prospective TAVI registry, patients with rheumatic AS were identified based on International Classification of Diseases version 10 codes and/or a documented history of acute rheumatic fever and/or the World Heart Federation criteria for echocardiographic diagnosis of RHD, and were propensity score-matched in a 1:4 ratio to patients with degenerative AS.

Results Among 2329 patients undergoing TAVI, 105 (4.5%) had rheumatic AS. Compared with patients with degenerative AS, patients with rheumatic AS were more commonly female, older, had higher surgical risk and more commonly suffered from multivalvular heart disease. In the unmatched cohort, both technical success (85.7% vs 85.9%, p=0.887) and 1-year cardiovascular mortality (10.0% vs 8.6%; HR 1.16, 95% CI 0.61 to 2.18, p=0.656) were comparable between patients with rheumatic and degenerative AS. In contrast, patients with rheumatic AS had lower rates of 30-day and 1-year cardiovascular mortality compared with matched patients with degenerative AS (1.9% vs 8.9%, adjusted HR (HRadj) 0.18, 95% CI 0.04 to 0.80, p=0.024; and 10.0% vs 20.3%, HRadj 0.44, 95% CI 0.24 to 0.84, p=0.012, respectively).

Conclusion TAVI may be a safe and effective treatment strategy for selected elderly patients with rheumatic AS.

Trial registration number NCT01368250.

  • aortic stenosis
  • transcatheter aortic valve replacement

Data availability statement

Data are available upon reasonable request. The data underlying this article were provided by CTU, University of Bern, by permission. Data will be shared on request to the corresponding author with permission from CTU, University of Bern.

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Data availability statement

Data are available upon reasonable request. The data underlying this article were provided by CTU, University of Bern, by permission. Data will be shared on request to the corresponding author with permission from CTU, University of Bern.

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Footnotes

  • TO and DT are joint first authors.

  • Twitter @taishiokuno, @DaijiroTomii, @CaglayanDmrl, @DanielHagemeyer, @FabienPraz, @StefanStortecky, @ThomPilgrim

  • TO and DT contributed equally.

  • Contributors TO, DT and TP conceived the study. TO and TP were responsible for the design of the study. TO, DT, TP, EB, JL, CR, CD, SH, DHa, AP, DHe, FP, SS and SW were responsible for the acquisition of data. DHe and TO did the analysis and interpreted the results in collaboration with TP, DT and all other authors. TO, DT and TP wrote the first draft of the report. TO and TP are guarantors for the manuscript. All authors critically revised the report for important intellectual content and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests SW reports research and educational grants to the institution from Abbott, Amgen, AstraZeneca, BMS, Bayer, Biotronik, Boston Scientific, Cardinal Health, CardioValve, CSL Behring, Daiichi Sankyo, Edwards Lifesciences, Guerbet, InfraRedx, Johnson & Johnson, Medicure, Medtronic, Novartis, Polares, OrPha Suisse, Pfizer, Regeneron, Sanofi-Aventis, Sinomed, Terumo and V-Wave. SW serves as unpaid advisory board member and/or unpaid member of the steering/executive group of trials funded by Abbott, Abiomed, Amgen, AstraZeneca, BMS, Boston Scientific, Biotronik, CardioValve, Edwards Lifesciences, MedAlliance, Medtronic, Novartis, Polares, Sinomed, V-Wave and Xeltis, but has not received personal payments by pharmaceutical companies or device manufacturers. He is also member of the steering/executive committee group of several investigator-initiated trials that receive funding by industry without impact on his personal remuneration. SW is an unpaid member of the Pfizer Research Award selection committee in Switzerland and of the Women as One Awards Committee. TP reports research grants to the institution from Edwards Lifesciences, Boston Scientific and Biotronik, personal fees from Biotronik and Boston Scientific, and other from HighLife SAS. FP reports travel expenses from Abbott, Edwards Lifesciences and Polares Medical. SS reports research grants to the institution from Edwards Lifesciences, Medtronic, Boston Scientific and Abbott, as well as personal fees from Boston Scientific, Teleflex and BTG. TO reports speaker fees from Abbott. DHe is with CTU Bern, University of Bern, which has a staff policy of not accepting honoraria or consultancy fees. However, CTU Bern is involved in design, conduct or analysis of clinical studies funded by not-for-profit and for-profit organisations. In particular, pharmaceutical and medical device companies provide direct funding to some of these studies. For an up-to-date list of CTU Bern’s conflicts of interest, see http://www.ctu.unibe.ch/research/declaration_of_interest/index_eng.html. All other authors have no relationships relevant to the content of this article to disclose.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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