Transcatheter aortic valve implantation
| Autor: | Samuel V. Lichtenstein, David A. Wood, Namal Wijesinghe, John G. Webb, Ronen Gurvitch, Edgar Tay, Fabian Nietlispach, Anson Cheung, Jian Ye |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Time Factors Transcatheter aortic Risk Assessment Risk Factors Internal medicine Occlusion medicine Humans Radiology Nuclear Medicine and imaging Hospital Mortality Registries Stroke Aged Proportional Hazards Models Aged 80 and over Heart Valve Prosthesis Implantation High risk patients British Columbia business.industry Incidence (epidemiology) Aortic Valve Stenosis General Medicine medicine.disease Survival Analysis Surgery Stenosis Treatment Outcome Coronary vessel Cardiology Regression Analysis Female Clinical Competence Cardiology and Cardiovascular Medicine business Complication Learning Curve |
| Zdroj: | Catheterization and Cardiovascular Interventions. 78:977-984 |
| ISSN: | 1522-1946 |
| DOI: | 10.1002/ccd.22961 |
| Popis: | Background: Transcatheter aortic valve implantation (TAVI) is a rapidly evolving strategy for therapy of aortic stenosis. We describe the effect of the learning curve from the first 270 high-risk patients in Vancouver, Canada. Methods: Patients underwent TAVI by transfemoral (63%) or transapical (37%) routes using balloon expandable valves. The experience was divided into the first half (FH, patients 1–135) and second half (SH, patients 136–270). Results: The mean age was 83.2 ± 8 years (FH 83 ± 12 vs. SH 81 ± 7 years, P = 0.12). The mean Society of Thoracic Surgeons Score (STS) was 9.5% ± 5.2%- FH 10.5 vs. SH 8.5% (P = 0.01). The overall procedural success rate in the FH was 92.6%, improving to 97.8% in the SH (P = 0.05). The transfemoral procedural success improved—FH 89.3% to SH 98.8% (P = 0.01). The transapical procedural success remained high—FH 98.0% to SH 96.1% (P = 0.53). The overall 30-day mortality was 9.6%, improving from FH 13.3% to SH 5.9% (P = 0.04). In the transfemoral cases, 30-day mortality decreased by 56% [10.7–4.7%, P = 0.14], and similarly in transapical cases [17.6–7.8%, P = 0.14]. In-hospital stroke occurred in 3.3% (FH 3.7% vs. SH 2.9%, P = 0.74). The overall need for a new permanent pacemaker was 5.9% (FH 5.9% vs. SH 5.9%, P = 1). The overall major vascular injury rate was 6.7% (FH 8.1% vs. SH 5.2%, P = 0.33). The overall incidence of coronary vessel occlusion was 1.1% (FH 1.5 % vs. SH 0.7%, P = 0.56). Device embolization or failure to cross the valve was rare and largely seen in the FH only. Procedural experience (>135 procedures) was an independent predictor of 30-day survival (HR: 6.7, 95% CI: 1.2–18.1, P = 0.03). Conclusion: TAVI outcomes improve with experience and device development. While overall complication rates are low, scope remains to further reduce procedural adverse events.© 2011 Wiley Periodicals, Inc. |
| Databáze: | OpenAIRE |
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