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.

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Surgical aortic valve replacement in the elderly is now being supplanted by transcatheter aortic valve implantation (TAVI). Scoring systems to predict survival after catheter-based procedures are understudied. Both diabetes (DM) and underlying inflammatory conditions are common in patients undergoing TAVI, but their impact remains understudied in this patient group. We examined 560 consecutive TAVI procedures and identified eight pre-procedural factors: age, body mass index (BMI), DM, fasting blood glucose (BG), left-ventricular ejection fraction (EF), aortic valve (AV) mean gradient, C-reactive protein levels, and serum creatinine levels and studied their impact on survival. The overall mortality rate at 30 days, 1 year and 2 years were 5.2%, 16.6%, and 34.3%, respectively. All-cause mortality was higher in patients with DM (at 30 days: 8.9% vs. 3.1%, p = 0.008; at 1 year: 19.7% vs. 14.9%, p = 0.323; at 2 years: 37.9% vs. 32.2%, p = 0.304). The presence of DM was independently associated with increased 30-day mortality (hazard ratio [HR] 5.38, 95% confidence interval [CI], 1.24–23.25, p = 0.024). BG levels within 7–11, 1 mmol/L portended an increased risk for 30-day and 2-year mortality compared to normal BG (p = 0.001 and p = 0.027). For each 1 mmol/L increase in BG 30-day mortality increased (HR 1.21, 95% CI, 1.04–1.41, p = 0.015). Reduced EF and elevated CRP were each associated with increased 2-year mortality (p = 0.042 and p = 0.003). DM, elevated BG, reduced EF, and elevated baseline CRP levels each are independent predictors of short- and long-term mortality following TAVI. These easily accessible screening parameters should be integrated into risk-assessment tools for catheter-based aortic valve replacement candidates.

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.