Causes and temporal trends in procedural deaths after transcatheter aortic valve implantation.

Autor: Terzian Z; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Urena M; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Himbert D; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France. Electronic address: dominique.himbert@aphp.fr., Gardy-Verdonk C; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Iung B; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Bouleti C; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Brochet E; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Ghodbane W; Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Depoix JP; Anaesthesiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Nataf P; Cardiac Surgery Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France., Vahanian A; Cardiology Department, DHU FIRE, Bichat Hospital, AP-HP, 75018 Paris, France.
Jazyk: angličtina
Zdroj: Archives of cardiovascular diseases [Arch Cardiovasc Dis] 2017 Nov; Vol. 110 (11), pp. 607-615. Date of Electronic Publication: 2017 Apr 12.
DOI: 10.1016/j.acvd.2016.12.008
Abstrakt: Background: The causes of procedural deaths after transcatheter aortic valve implantation (TAVI) have been scarcely detailed.
Aims: To assess these causes and their temporal trends since the beginning of the TAVI era.
Methods: From October 2006 to April 2014, 601 consecutive high-risk/inoperable patients with severe aortic stenosis underwent TAVI using the Edwards SAPIEN or SAPIEN XT or the Medtronic CoreValve. The transfemoral route was the default approach; the transapical or left subclavian approaches were alternative options. Patients were divided into three tertiles according to the date of the procedure.
Results: Procedural death occurred in 45 patients (7.5%), with a median±standard deviation age of 83±7 years; 23 were men (51%) and the mean logistic EuroSCORE was 26±16%. The main cause of death was heart failure (n=19, 42%), followed by cardiac rupture (n=12, 27%), intensive care complications (n=9, 20%) and vascular complications (n=5, 11%). The mortality rate was higher after transapical than transfemoral TAVI (17% vs. 5%; P<0.001). The mortality rate decreased over time (11.9% in the first tertile, 6.0% in the second and 4.5% in the third [P=0.007]), driven by a reduction in heart failure-related deaths (6.5% in the first tertile vs. 1.5% in the third; P=0.011). Vascular complication-related deaths disappeared in the third tertile. However, there was no decrease in deaths related to cardiac ruptures and intensive care complications.
Conclusions: The procedural mortality rate of TAVI decreased over time, driven by the decrease in heart failure-related deaths. However, efforts should continue to prevent cardiac ruptures and improve the outcomes of patients requiring intensive care after TAVI.
(Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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