Outcomes after Transcatheter Aortic Valve Implantation: a Single Center Registry of 350 Consecutive Cases

Autor: Lukas Altwegg, Ines Bühler, W. Maier, Roberto Corti, Ulf Landmesser, Felix C. Tanner, Thomas F. Lüscher, Volkmar Falk, Manfred Wischnewsky, Barbara E. Stähli, Hanna Tasnady, Jürg Grünenfelder
Rok vydání: 2013
Předmět:
Zdroj: Cardiovascular Medicine. 16:235-242
ISSN: 1664-204X
1664-2031
DOI: 10.4414/cvm.2013.00181
Popis: Summary Introduction: The Valve Academic Research Consor- tium (VARC) consensus document on outcome report- ing in transcatheter valves has recently been revised. We used these VARC-2 standardised endpoint defini- tions to report transcatheter aortic valve implantation (TAVI) outcome at our institution. Methods: The study included 350 consecutive patients undergoing TAVI at the University Hospital Zurich be- tween May 2008 and November 2012. The Edwards SAPIEN (n = 158; 45%), the Medtronic CoreValve (n = 189, 54%), and the Medtronic Engager (n = 3, 1%) pros- theses were implanted via either the transfemoral (83%) or the transapical (17%) access. Mean follow-up was 389 ± 405 days. Results: Device success within 72 hours was achieved in 88% of patients without significant differences be- tween access sites (p = 0.89) and prosthesis types (p = 0.24). Device failure was due to procedural mortality in 12 (3.4%) patients. In survivors, implantation of more than one prosthesis or malpositioning of the prosthesis was observed in six (1.7%) patients, an increased trans- valvular pressure gradient >20 mm Hg in four (1.1%) patients, and moderate aortic re- gurgitation in 19 (5.4%) patients, respectively. Severe aortic regurgi- tation was observed in one (0.3%) patient. All-cause mortality was 9.1% at 30 days (12.0% in the first half of the patients vs 6.3% in the second half; p = 0.07), and 21.2% at 1 year. The composite endpoint "early safety" was met in 67 (19.1%) patients at 30 days (23% in the first half of the patients vs 15% in the second half; p = 0.04). Stroke was o bserved in 2.9%, life-threatening bleeding in 4.6%, vascular compli- cations in 7.4% and acute renal failure in 5.7% of patients. Coro- nary obstruction was rarely observed (0.9%). Valve-re- lated dysfunction requiring repeat procedure occurred in two (0.6%) patients. With multivariate regression analysis, major and life-threatening bleeding within 30 days (hazard ratio (HR) 4.74, 95% confidence interval (CI) 2.03-11.07, p
Databáze: OpenAIRE
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