Excellent outcomes for transcatheter aortic valve replacement within 1 year of opening a low-volume centre and consideration of requirements
| Autor: | Melanie Gallant, Frédéric Poulin, Ismail El-Hamamsy, Philippe Demers, Pierre Pagé, Karim Serri, Donald A. Palisaitis, Florent Chevalier, Yanick Beaulieu, Hugues Jeanmart, Van Hoai Viet Le, Anik Daoust, Christophe Heylbroeck, Yoan Lamarche, Philippe Généreux, Erick Schampaert |
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| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Cardiac Catheterization Hospitals Low-Volume Time Factors medicine.medical_treatment Prosthesis Design Transcatheter Aortic Valve Replacement Valve replacement medicine Humans Heart valve Embolization Registries Stroke Retrospective Studies Aortic dissection Aged 80 and over business.industry Aortic Valve Stenosis medicine.disease Surgery Stenosis medicine.anatomical_structure Treatment Outcome Cardiothoracic surgery Coronary occlusion Heart Valve Prosthesis Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Canadian journal of cardiology. 30(12) |
| ISSN: | 1916-7075 |
| Popis: | Background After the approval of transcatheter aortic valve replacement (TAVR) for high-risk or inoperable patients with severe aortic stenosis (AS), many low- and moderate-volume TAVR programs were initiated. Contemporary outcomes from these newly initiated centres remain unknown. Methods In March 2013, our institution was authorized by the Quebec Ministry of Health to perform 30 TAVR procedures. After thorough clinical screening and imaging evaluation, suitable patients underwent transfemoral TAVR with the balloon-expandable SAPIEN XT (Edwards Lifesciences, Irvine, CA) transcatheter heart valve (THV). In-hospital and 30-day outcomes were prospectively collected and reported according to Valve Academic Research Consortium 2 guidelines. Results From April 2013 to January 2014, 30 consecutive high-risk (n = 16 [53.3%]) or inoperable (n = 14 [46.7%]) patients (mean age, 84.6 years; mean Society of Thoracic Surgery score, 7) with symptomatic severe AS underwent transfemoral TAVR. No catastrophic intraprocedural complications such as annulus rupture, valve embolization, aortic dissection, or coronary occlusion occurred, and there were no deaths at 30 days. Disabling stroke occurred in 1 (3.3%) patient 48 hours after THV implantation. Major vascular complications and major bleeding occurred in 1 (3.3%) patient. No moderate or severe paravalvular leak was observed. The median length of stay was 2 (1-3) days, with 8 (26.7%) patients discharged within 24 hours after the procedure. Conclusions Excellent outcomes can be achieved in newly initiated relatively low-volume centres, which compares favorably to previously published large series. Important considerations include appropriate team training, rigorous patient screening, use of multimodality imaging techniques, a heart team approach, constant integration of lessons learned from larger published experiences, and maintaining a recommended minimum volume of 25 cases per year. |
| Databáze: | OpenAIRE |
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