Doma, Mohamed

Background:Aortic valve replacement is the primary treatment for aortic valve disease and can be performed using either transcatheter (TAVR) or surgical (SAVR) approaches. The risk of aortic dissection (AD) with TAVR compared with SAVR remains unclear. We aimed to compare AD risk between TAVR and SAVR using a large, real-world cohort. Methods:We conducted a retrospective cohort analysis using the TriNetX research network. Patients with a diagnosis of aortic stenosis, aortic insufficiency, mixed aortic valve disease (AVD), or unspecified AVDwho underwent either TAVR or SAVR were included. A 1:1 propensity score-matching (PSM) based on baseline characteristics was performed to adjust for potential confounding. Logistic regression and Cox proportional hazards models were used to estimate odds ratios (ORs) and hazard ratios (HRs), with 95% confidence intervals (CIs).Results:Among 95,043 patients undergoing isolated aortic valve replacement, 20,237 matched pairs were analyzed after 1:1 PSM. Baseline characteristics were well balanced, with a mean age of 73.3 ± 9.3 years in the TAVR group and 73.2 ± 8.5 years in the SAVR group; 60.8% and 60.7% were male, respectively. TAVR was associated with significantly lower odds of composite AD than SAVR at all time points (1-year OR 0.60; 95% CI 0.44–0.82; 3-year OR 0.64; 95% CI 0.48–0.83; 5-year OR 0.66; 95% CI 0.51–0.85; p < 0.01 for all). Stratified analyses demonstrated lower odds of both Stanford type A and type B AD at all time points. Kaplan–Meier analysis demonstrated a separation in composite AD-free survival between the two groups (HR 0.66; 95% CI 0.51–0.86; p = 0.002).Conclusion:In this large, real-world cohort, despite a low event rate, TAVR was associated with a significantly lower likelihood of composite AD than SAVR.

Abstract Objective To evaluate the short- and long-term clinical outcomes of transcatheter aortic valve replacement (TAVR) among participants with RA and aortic stenosis compared with those without RA, using real-world data from a large multicentre registry. Methods Using the TriNetX Research Network, participants with aortic stenosis undergoing TAVR with (RA+) vs without (RA−) RA were identified. Odds ratios (ORs) with 95% CIs estimated 30-day all-cause mortality, permanent pacemaker implantation, ischaemic stroke, acute kidney injury, myocardial infarction, cardiogenic shock, major vascular complications, and major or life-threatening bleeding were evaluated. Five-year outcomes included all-cause mortality, ischaemic stroke, myocardial infarction and all-cause hospitalization. Cox regression was used to estimate hazard ratios (HRs) with 95% CIs. Results A total of 1414 RA+ (4.3%) and 39 004 RA− participants were eligible. After matching, 1374 were included in each cohort. At 30 days, outcomes did not differ between RA+ and RA− groups; mortality was 2.0% vs 1.5% (OR 1.29; 95% CI 0.73–2.29), with no significant differences in other endpoints. Over 5 years, mortality was 23.8% vs 20.5% (OR 1.12; 95% CI 0.97–1.31), and stroke, myocardial infarction and hospitalization were similar; HRs were concordant with OR estimates. In sex-based analyses of RA patients, outcomes did not differ by sex. Conclusion In this large observational study, TAVR was not associated with excess short- or long-term risk in patients with RA. These findings support TAVR as a safe therapeutic option in RA patients with aortic stenosis.

ABSTRACT Background Concomitant atrial fibrillation (AF) and gastrointestinal (GI) bleeding present a clinical challenge due to recurrent bleeding risk associated with anticoagulation for AF‐associated stroke prevention. Left atrial appendage occlusion (LAAO) offers an alternative stroke prevention strategy, but its impact on recurrent GI bleeding remains unknown. Methods This retrospective, multicenter cohort study used the TriNetX database to identify adults with AF on oral anticoagulation and a history of GI bleeding. Patients were stratified by treatment with or without LAAO. 1:1 propensity score matching (PSM) was employed. The primary outcome was recurrent GI bleeding. Cox regression analysis was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs). Odds ratios (ORs) were used to evaluate effect sizes between groups. Kaplan–Meier curves were used for time‐to‐event analyses. Results After PSM, 9259 patients were compared in each group. Odds of recurrent GI bleeding were consistently lower in patients undergoing LAAO than without LAAO across all follow‐up intervals: at 3 months (OR 0.84; 95% CI 0.78–0.91), 6 months, 1 year, 3 years, and 5 years (OR 0.87; 95% CI 0.82–0.92). Kaplan–Meier analysis demonstrated significantly lower risk of recurrent GI bleeding with LAAO (HR 0.80; 95% CI 0.76–0.84; p < 0.01). Conclusion In patients with AF and prior GI bleeding, LAAO was associated with a significantly lower risk of recurrent GI bleeding at short‐term and long‐term time intervals.