Bevezetés: Napjainkban a súlyos panaszos aortastenosis kezelésében a transzkatéteres billentyűimplantáció a sebészi billentyűcsere elérhető alternatíváját jelenti sebészi kontraindikáció és elfogadhatatlanul magas műtéti kockázat esetén. A szerzők intézetében ez a beavatkozás ma már a mindennapi rutin részének számít. Célkitűzés: A szerzők az első 200, transzkatéteres billentyűimplantációban részesült beteg eredményeit tárgyalják. Módszer: 2016. januárig 200 sikeres implantáció történt. A betegek 55%-a nő, átlagéletkoruk 79,9 év volt, az átlagos EuroSCORE: 19,3%, az át-lagos ejekciós frakció: 54%, az aortabillentyűn mérhető csúcsgradiens 81,2 Hgmm, az átlaggradiens: 50,9 Hgmm volt. Eredmények: A beavatkozásokat 99%-os sikeraránnyal végezték, a szövődmények feldolgozása a VARC-2 kritéri-umrendszer alapján történt. Az egy hónapos mortalitás 5%, az egyéves pedig 17,4% volt, utóbbiból a kardiális mortalitás 13,6% volt. Az egyéves cerebrovascularis történések előfordulása 5% volt. Az egyéves kontroll során a betegek 95%-a NYHA I vagy II funkcionális állapotban volt. Következtetés: Az eredmények nem térnek el lényegesen a nemzetközi vizsgálatok eredményeitől. Orv. Hetil., 2016, 157(45), 1786-1792. Kulcsszavak: aortastenosis, transzkatéteres billentyűimplantáció The first 200 transcatheter aortic valve implantations in the Gottsegen György Institute of Cardiology, HungaryIntroduction: Transcatheter aortic valve implantation is a therapeutic alternative for contraindicated and high surgical risk patients with severe symptomatic aortic stenosis. This intervention is part of daily routine in the Institute of the authors. Aim: In the present work the results of the first 200 patients are discussed. Method: Until January, 2016, 200 patients (female 55%, mean age 79.9 years, average EuroSCORE 19.3%, left ventricular ejection fraction 54%, peak gradient 81.2 mmHg, mean aortic gradient 50.9 mmHg) underwent transcatheter aortic valve implantation. Results:The procedure was performed with 99% success rate. Complications were evaluated according to VARC 2 definitions. Mortality was 5% at one month and 17.4% at one year. Cardiac mortality was 13.6 at one year. Cerebrovascular complications were 5% within one year, and 95% of patients were in NYHA I or II functional classes at one year. Conclusion: These findings are consistent with worldwide results.
PurposeOutcomes for different subtypes of aortic stenosis (AS) after transcatheter aortic valve implantation (TAVI) are still subjects of debate. The aim of the study was to evaluate the prognostic impact of baseline flow rate (F) and mean gradient (G) on survival after TAVI. MethodsFrom 2008. to 06. 2017. TAVI was performed in 300 cases (127 men, 173 women, age 80,0±5,8 years) with severe AS. Follow-up was at least 3 years. Mortality tracking was 100%. Patients were divided into high gradient (HG: 237), low-flow low-gradient (LF-LG: 41), paradoxically low flow-low gradient (PLF-LG: 9) and normal flow-low gradient (NF-LG: 13) groups. Primary endpoint was 30-day, 1-year and 3-year all-cause mortality (M) . ResultsNF-LG had better prognosis (M: 30d 0, 1-year: 7,7%, 3-year: 46,2%). In HG patients mortality was low in the 1st year (30-day: 3,8%, 1-y: 14,3%), but higher (62,8%) after 3 year. PLF-LG had intermediate outcomes (30-day 0, 1-year 22,2%, 3-year 55,6%). LF-LG had the highest mortality (30-day 12,2%, p=0,03, 1-year 34,2% p=0,005, 3-year 75,6% p=0,009 vs.HG) and relative risk (2,44 [1,34-4,42] p=0,003 vs.HG). Independent predictors of 1-year mortality were only Grade 2+ paravalvular regurgitation (p=0,04) and severe renal dysfunction (p=0,04). ConclusionsTAVI survival is determined by the guideline-defined subtype of AS. Low flow – low gradient AS is associated with worse prognosis, therefore these patients need careful management after TAVI.
Background Outcomes for different subtypes of aortic stenosis defined by transvalvular flow and gradient after transcatheter aortic valve implantation (TAVI) are still subjects of debate. Purpose The aim of the study was to evaluate the prognostic impact of the initial transvalvular flow rate and aortic mean gradient on survival and to assess the changes of left ventricular function after TAVI. Patients and Methods From 2008. to 2017.06.30. TAVI was performed in 300 cases in our Institute (127 men, 173 women, mean age 80,0 ± 5,8 years) with severe (aortic valve area <1,0 cm²) symptomatic aortic stenosis (AS) and contraindication or high risk for surgery. Median time for follow-up was 28 (0-115) months, Echocardiography was performed before and 12 months after TAVI. Patients were divided into four groups according to flow (F) , aortic mean gradient (Gr) and ejection fraction (EF): HG Gr ≥ 40 mmHg (n = 237) LF-LG : F ≤ 35 ml/m2, Gr < 40 mmHg and EF < 50% (n = 41) PLF-LG: F ≤ 35 ml/m2, Gr < 40 mmHg and EF ≥50% (n = 9) NF-LG: F > 35 ml/m2 and Gr < 40 mmHg (n = 13) Our primary objective was the analysis of 30-day, 1-year and 3-year all-cause mortality of these groups, secondary goal was to observe the changes in EF after 12 months in the survivors. Results In the whole patient group 30-day all-cause mortality was 4,3%, 1-year 17,0% and 3-year 62,0%. The NFLG group had the most favourable outcomes (mortality: 30d 0, 1-year: 7,7%, 3-year: 46,2%). Mortality was low in the HG group in the 1st year (30-day: 3,8%, 1-y: 14,3%), but it increased to 62,8% at 3-year. Mortality rates were intermediate in the PLF-LG group (30-day 0, 1-year 22,2%, 3-year 55,6%) and were the highest in LF-LG (30-day 12,2%, p = 0,03 vs HG, 1-year 34,2% p = 0,005 vs. HG, 3-year 75,6%). Among clinical and echocardiographic variables only moderate or severe paravalvular aortic regurgitation (p = 0,03) and severe renal dysfunction (GFR <30 ml/min, p = 0,02) were independent predictors of all-cause 1-year mortality. In patients with severe (EF < 30%) , moderate (EF 30-40%) or mild ( EF 41-50%) systolic dysfunction the EF improved after TAVI (23,5 ± 3,5% vs. 30,3 ± 7,9% p < 0,001, 33,6 ±3,6% vs. 43,0 ± 10,5% p = 0,003, 45,5 ± 3,1% vs. 54,3 ± 8,7% p < 0,001) regardless of the initial flow and gradient subtype of AS. Conclusions Low flow-low gradient aortic stenosis is associated with worse short or long term prognosis after TAVI, therefore this subtype of AS needs detailed risk stratification before-, and careful management after TAVI. Improvement of initial left ventricular dysfuncion can be expected after TAVI.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.