Patients undergoing transcatheter pulmonary valve replacement (TPVR) using a Sapien valve had satisfactory short-term clinical outcomes, according to a study published in the Journal of the American College of Cardiologists.

In this study, data from patients (N=774; median age, 24 years) who underwent TPVR at 23 centers between 2008 and 2019 were retrospectively collected. All procedures in which a Sapien device was used were included (Sapien S3, 78%; Sapien XT, 22%). In this cohort, 51% of patients had native or patched right ventricular outflow tract, and 25% and 24% had dysfunctional a bioprosthetic valve and right ventricle-to-pulmonary artery conduit, respectively. Patients were assessed for procedure success and clinical outcomes at a median of 12 months.

Stratified by procedure type, patients differed significantly for cardiac diagnosis (P <.001), history of endocarditis (P <.001), baseline echocardiogram (P <.001), indication for TPVR (P <.001), age group (P =.010), gender (P =.001), and weight (P =.022).


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Most procedures (93%) were accessed through the femoral vein. A majority of patients received a 29 mm valve (39%) or a 26 mm valve (34%).


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Valve implantation was deemed successful in 97.4% of patients. The remaining 20 procedures were deemed unsuccessful (removal within 24 hours, n=14; not implanted, n=4; procedure-related death, n=2). Stratified by body weight, patients who were <30 kg vs ≥30 kg had a lower success rate (90.4% vs 97.9%, respectively; P =.008).

Serious adverse events were observed in 67 patients (10%), and included malposition of the valve (n=21) or pre-stent (n=9), emergency surgery due to malposition of the TPV (n=11) or pre-stent (n=1), and requirement for additional valve implantation (n=5), aortic surgery (n=1), and coronary artery compression surgery (n=1).

Acute surgery postprocedure was higher among patients who had native/patched (2.5%) vs with conduit (1.1%) or bioprosthetic valve (1.0%) procedures. Patients weighing <30 kg vs ≥30 kg were more likely to have post-procedure acute surgery (7.7% vs 1.4%, respectively; P =.011).

A total of 46% of patients had follow-up data with a median of 12 months. Few patients (5.5%) had new moderate (n=15) or severe (n=4) pulmonary regurgitation and 3 patients had worsening of previous symptoms. The median peak Doppler gradient was 18 mmHg. Endocarditis was diagnosed in 9 patients, 2 of whom had a known history. Twenty patients required reintervention surgery.

A total of 14 patients (1.8%) died (native/patched, n=10; conduit, n=3; BPV, n=1). None of these deaths were associated with the TPVR procedure.

Study limitations include the lack of core laboratory evaluations postprocedure.

The study authors concluded that TPVR procedures with Sapien XT or S3 devices had positive outcomes, especially among patients undergoing conduit or bioprosthetic valve procedures. This registry will continue to monitor these patients for long-term clinical outcomes associated with the use of Sapien devices.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.

Reference

Shahanavaz S, Zahn E M, Levi D S, et al. Transcatheter Pulmonary Valve Replacement With the Sapien Prosthesis. J Am Coll Cardiol. 2020;76(24):2847-2858. doi:10.1016/j.jacc.2020.10.04

Gout diagnosis is associated with increased length of stay in patients hospitalized for heart failure exacerbation, according to study results presented at the American College of Rheumatology (ACR) Convergence 2020, held virtually from November 5 to 9, 2020.

Although previous studies have reported that hospital stay is a risk factor for acute gout flare, which may increase length of stay, limited data are available on the effect of gout diagnosis and flare on the length of stay in patients hospitalized for heart failure exacerbation.

Study authors collected data from electronic health records of patients admitted to the Columbia University Irving Medical Center. Patients eligible for the study were aged at least 18 years, hospitalized with a primary diagnosis of heart failure exacerbation from July 2012 to June 2017, and had 2 or more gout diagnoses before hospitalization for heart failure. Patients were age- and sex-matched 1:2 with control participants who did not have any diagnosis of gout before hospitalization. Primary study outcome was length of stay. Two-sample t-test and linear mixed effect model were used for statistical analysis.

The case-control study included 545 admissions for heart failure exacerbation among 293 patients with a history of gout, and 5461 admissions among 3798 patients without a history of gout. Overall, 246 admissions of patients with gout and 492 admissions of matched control participants without gout were included in the analysis.

Results showed significantly longer hospital stays for patients with a history of gout compared with those without gout (log length of stay, 1.86 vs 1.72 days, respectively; P =.0278). A gout flare was reported in 42 of 326 admissions (13%) and the median length of stay for patients with a gout flare was longer than that of those without a flare (10 vs 6 days) or without gout (6 days). There was a significant difference between patients who experienced a flare compared with control participants (log length of stay, 2.41 vs 1.77 days, respectively; P <.0001). However, no significant difference was reported between patients with gout who did not experience a flare and control participants (P =.2465).

After adjustment for study variables, including age, baseline electrolytes, and body mass index, the length of stay remained significantly longer for patients with gout flare compared with control participants (P <.0001), but not for those who did not experience a flare (P =.042).

“Patients [with heart failure] with gout had significantly longer hospitalizations than those without gout, an effect driven primarily by those patients [with gout] who flare during hospitalization,” the study authors concluded.

Reference

DeMizio D, Wu G, Wei Y, Bathon J, Wang R. Gout increases length of stay in patients hospitalized for heart failure exacerbation. Presented at: ACR Convergence 2020; November 5-9, 2020. Abstract 0600.

This article originally appeared on Rheumatology Advisor