BAV is an effective treatment strategy, either as a bridge to definitive therapy or as a palliative procedure, with an acceptable mortality. BAV is associated with a significant improvement in symptoms and is valuable as a palliative treatment in high-risk patients, where no other invasive option is available.
Background: Transcatheter Aortic Valve Replacements (TAVR) has become
widespread throughout the world. To date there are no echocardiographic
study of TAVR patients from Southeast Asia (SEA). We sought to evaluate
1) changes in echocardiographic and strain values pre and post TAVR 2)
relationship between aortic stenosis (AS) severity and strain values, 3)
left ventricle geometry in severe AS 4) relationship of flow rate to
dimensionless index (DVI) and acceleration time (AT) and 5) effect of
strains on outcome. Methods: Retrospective study of 112 TAVR patients in
our center from 2009 to 2020. The echocardiographic and strain images
pre (within 1 months), post (day after) and 6 months post TAVR were
analyzed by expert echocardiographer. Results: The ejection fraction
(EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%)
(p=0.044). Interventricular septal thickness in diastole (IVSd)
decreased (1.27 ± 0.21cm to 1.21 ± 0.23cm) (p=0.038) and left ventricle
internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64cm to
4.49 ± 0.65cm (p = 0.001). No changes in stroke volume index (SVI pre vs
6 months p =0.187), but the flow rate increases (217.80 ± 57.61mls/s to
251.94 ± 69.59mls/s, p<0.001). Global Longitudinal Strain
(GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p
<0.001), Left Atrial Reservoir strain (Lar-S) increased from
17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). 8 patients (7.5%) had IVSd
< 1.0cm, and 4 patients (3.7%) had normal left ventricle (LV)
geometry. There was linear relationship between IVSd and mean PG
(r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic
valve area index (AVAi) (r = – 0.305, p=0.001 and r= – 0.316, p =
0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI
(r=0.35, p< 0.001) with flow rate. Patients who died late
(after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs
Died; -12.43 ± 4.19%, p= 0.001) Conclusion: At 6 months TAVR cause
reverse remodeling of the LV with reduction in IVSd, LVIDd and
improvement in GLS and LAr-S. There is linear relationship between GLS
and AVA and between IVSd and AVA.
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Transcatheter Aortic Valve Implantation (TAVI) had revolutionized the treatment and outcome of symptomatic severe aortic stenosis (AS) since its introduction. In 2009, our center performed the first TAVI in Malaysia and since then it has provided an alternative treatment for severe AS patients. The objective of the study is to evaluate the clinical outcome of severe AS patients who had undergone TAVI in our center.
METHODS
A retrospective observational study was conducted. All TAVIs performed in our center between 01 Jan 2009 and 31 December 2020 were included. Patients’ baseline characteristic, clinical outcomes post procedure at 1-year and 3-year mortality were studied. Data were collected by using case report form and reviewing patient’s case note.
RESULTS
A total of 107 patients had TAVI performed during this period of time. The mean age (±SD) was 77.4 ± 5 (range 61-90 years). 50.5% of the patients were male (n = 54) and 45.8% were Malay ethnicity (n = 49). Majority of the patients had hypertension (86.9%, n = 93), dyslipidaemia (84.1%, n = 90) and ischemic heart disease (60.7%, n = 65). 26.2% of patients (n = 28) had previous coronary artery bypass surgery and 2.8% of patients (n = 3) had previous valvular operation. 85.9% of patient was in NYHA II – IV (n = 92). Mean EuroScore II and STS score were 4.82 and 4.564 respectively. Average hospitalization stay was 5 days. Total of 60 (56.1%) CoreValve were deployed followed by 46 Edwards Sapien (43%) and 1 MyVal (0.9%). 89.7% of procedure was performed via transfemoral access (n = 96) followed by transapical (6.5%, n = 7), transaortic (2.8%, n = 3) and subclavian (0.9%, n = 1). 98.1% (n = 105) procedure was successfully performed. There were 6 in-hospital mortality (5.6%) during indexed TAVI admission, of which 5 out of 6 were TAVI related. Kaplan Meier analysis of predicted survival rate with freedom from all-causes mortality at 1 year was 86.9% and 73.7% at 3 years.
CONCLUSIONS
Untreated severe AS was associated with poor outcome. High success rate of TAVI had provided another option of treatment to severe AS patient who are not the suitable candidate for surgical intervention.
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