Clinical and hemodynamic outcomes of 'all-comers' undergoing transapical aortic valve implantation: Results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA)
| Autor: | D'Onofrio, Augusto, Rubino, P, Fusari, M, Salvador, L, Musumeci, F, Rinaldi, M, Vitali, Eo, Glauber, M, Bartolomeo, Di, R, Alfieri, Or, Polesel, E, Aiello, M, Casabona, R, Livi, U, Grossi, C, Cassese, M, Pappalardo, A, Gherli, T, Stefanelli, G, Faggian, Giuseppe, Gerosa, G. |
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| Přispěvatelé: | D'Onofrio, A, Rubino, P, Fusari, M, Salvador, L, Musumeci, F, Rinaldi, M, Vitali, Eo, Glauber, M, Di Bartolomeo, R, Alfieri, Ottavio, Polesel, E, Aiello, M, Casabona, R, Livi, U, Grossi, C, Cassese, M, Pappalardo, A, Gherli, T, Stefanelli, G, Faggian, Gg, Gerosa, G., A. D’Onofrio, P. Rubino, M. Fusari, L. Salvador, F. Musumeci, M. Rinaldi, E.O. Vitali, M. Glauber, R. Di Bartolomeo, O.R. Alfieri, E. Polesel, M. Aiello, R. Casabona, U. Livi, C. Grossi, M. Cassese, A. Pappalardo, T. Gherli, G. Stefanelli, G.G. Faggian, G. Gerosa |
| Rok vydání: | 2011 |
| Předmět: |
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Pulmonary and Respiratory Medicine Aortic valve Cardiac Catheterization medicine.medical_specialty Logistic euroscore Time Factors Intraoperative Complication Hemodynamics Kaplan-Meier Estimate Risk Assessment chemistry.chemical_compound patient survival Risk Factors Internal medicine Odds Ratio medicine Humans surgery Heart Valve Prosthesis Heart Valve Prosthesis Implantation Humans Italy In patient Prospective Studies Registries Aged Aged 80 and over Heart Valve Prosthesis Implantation Creatinine Chi-Square Distribution aortic valve implantation business.industry Aortic Valve Stenosis Odds ratio Hospitals Confidence interval Surgery Survival Rate Logistic Models Treatment Outcome medicine.anatomical_structure Italy chemistry Aortic Valve Heart Valve Prosthesis Cardiology Female Cardiology and Cardiovascular Medicine business Learning Curve |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 142:768-775 |
| ISSN: | 0022-5223 |
| Popis: | OBJECTIVE: The aim of this study was to assess clinical and hemodynamic outcomes of transapical aortic valve implantation (TA-TAVI) in patients enrolled in the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). METHODS: From April 2008 until November 2010, 504 patients from 20 Italian centers were enrolled in the I-TA registry. Mean logistic EuroSCORE and Society of Thoracic Surgeons score were 24% ± 16% and 11% ± 4%, respectively. Mean follow-up was 9.2 ± 6.5 months (range, 1-26 months). Outcomes were analyzed according to intraoperative complications, procedural volume (high-volume centers, >20 cases; low-volume centers, < 20 cases) and learning curve (first 50% cases vs second 50% cases of each center). RESULTS: All-cause overall mortality was 8.3% (42 patients). Device success was 99% (500/504 patients). Intraoperative severe complications occurred in 24 (4.8%) patients. Overall 2-year survival was 71.5% ± 6.2%. At discharge, peak and mean gradients were 16.4 ± 11.2 and 8.7 ± 4.1 mm Hg, respectively, and effective orifice area was 1.67 cm(2). These values remained stable at 3, 6, and 12 months after surgery. Independent risk factors for mortality after TA-TAVI were as follows: New York Heart Association class III and IV (odds ratio [OR], 4.43; 95% confidence intervals [CI], 1.28-15.40; P = .02); logistic EuroSCORE greater than 20 (OR, 1.83; 95% CI, 1.02-3.29; P = .04); creatinine concentration greater than 200 μmol/L (OR, 2.56; 95% CI, 1.07-6.15; P = .03), and intraoperative complications (OR, 5.80; 95% CI, 2.68-12.55; P < .001). There were no significant differences in outcomes between high- and low-volume centers and between the first and the second 50% of cases. CONCLUSIONS: TA-TAVI represents a safe and effective alternative treatment for patients who are inoperable or at high risk for surgery. The occurrence of an intraoperative complication significantly affects survival. Procedural volume and learning curve have no impact on patient survival. |
| Databáze: | OpenAIRE |
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