Early clinical outcome of aortic transcatheter valve-in-valve implantation in the Nordic countries

Autor: Andreas Rück, Kaj-Erik Klaarborg, Leo Ihlberg, Rolf Busund, Heikki Miettinen, Henrik Nissen, Alexander Wahba, Markku Eskola, Mika Laine, Lars Soendergaard, Jan Harnek, Niels Erik Nielsen
Jazyk: angličtina
Předmět:
Pulmonary and Respiratory Medicine
Male
medicine.medical_specialty
Cardiac Catheterization
Time Factors
Aortic Valve Insufficiency
Regurgitation (circulation)
Kaplan-Meier Estimate
030204 cardiovascular system & hematology
Aspiration pneumonia
Scandinavian and Nordic Countries
Prosthesis Design
03 medical and health sciences
0302 clinical medicine
Aortic valve replacement
Risk Factors
Internal medicine
medicine
Humans
030212 general & internal medicine
Myocardial infarction
Heart valve
Registries
Stroke
Finland
Aged
Retrospective Studies
Aged
80 and over
Heart Valve Prosthesis Implantation
business.industry
EuroSCORE
Aortic Valve Stenosis
Middle Aged
medicine.disease
3. Good health
Surgery
Prosthesis Failure
Stenosis
medicine.anatomical_structure
Treatment Outcome
Aortic Valve
Heart Valve Prosthesis
Cardiology
Female
business
Cardiology and Cardiovascular Medicine
Zdroj: Ihlberg, L, Nissen, H, Nielsen, N E, Rück, A, Busund, R, Klaarborg, K-E, Soendergaard, L, Harnek, J, Miettinen, H, Eskola, M, Wahba, A & Laine, M 2013, ' Early clinical outcome of aortic transcatheter valve-in-valve implantation in the Nordic countries ', Journal of Thoracic and Cardiovascular Surgery, vol. 146, no. 5, pp. 1047-1054 . https://doi.org/10.1016/j.jtcvs.2013.06.045
ISSN: 0022-5223
DOI: 10.1016/j.jtcvs.2013.06.045
Popis: Objective Transcatheter valve-in-valve implantation has emerged as an option, in addition to reoperative surgical aortic valve replacement, to treat failed biologic heart valve substitutes. However, the clinical experience with this approach is still limited. We report the comprehensive experience of transcatheter valve-in-valve implantation in the Nordic countries from May 2008 to January 2012. Methods A total of 45 transcatheter aortic valve-in-valve implantations were performed during the study period in 11 centers. The mean age of the patients was 80.6 years (range, 61-91), 26 were male and 19 were female, and the mean EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons score was 35.4, 16.3, and 14.6, respectively. The type of failure was stenosis and combined in 58% (mean and peak aortic valve gradient, 77 and 45 mm Hg, respectively) and regurgitation in 42% of cases. The SAPIEN/XT (Edwards LifeSciences, Irvine, Calif) and CoreValve (Medtronic Inc, Minneapolis, Minn) system was used in 33 and 12 cases, respectively. The access route was transapical in 25, transfemoral in 17, transaortic in 2, and subclavian in 1 case. The mean follow-up was 14.4 months. The periprocedural and postoperative outcomes were assessed using the Valve Academic Research Consortium criteria. Results No intraprocedural mortality occurred. The technical success rate was 95.6% (1 second valve implantation, 1 conversion to open surgery). The all-cause 30-day mortality was 4.4% (1 cardiac-related and 1 aspiration pneumonia). The major complications within 30 days included stroke in 2.2%, periprocedural myocardial infarction in 4.4%, and major vascular complication in 2.2% of patients. At 1 month, all but 1 patient had either no or mild paravalvular leakage, with a mean and peak valve gradient of 17 mm Hg (range, 4-38) and 30 mm Hg (range, 7-68), respectively. The mean gradient was greater than 20 mm Hg in 17% of patients and remained unchanged at 12 months. The 1-year survival was 88.1%. Conclusions Transcatheter valve-in-valve implantation is widely performed, albeit in small numbers, in most centers in the Nordic countries. The short-term results were excellent in this high-risk patient population, demonstrating a low incidence of device- or procedure-related complications. However, a considerable number of patients were left with suboptimal systolic valve performance with unknown long-term effects, warranting close surveillance after transcatheter valve-in-valve implantation.
Databáze: OpenAIRE
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