Aims: to determine long-term outcomes of high-risk patients who underwent transcatheter aortic valve implantation (TAVI) with third-generation CoreValve device, according to the 2017 EAPCI/ESC/EACTS definition of valve durability.Methods and results: between 2007 and 2013, 278 consecutive patients were enrolled in our prospective single-centre CoreValve registry (mean age 82±6 years, mean STS score 6.4±5.0%); median follow-up of survivors was 6.8 years. The Cox proportional hazards model was used to identify independent predictors of HF-rehospitalization and all-cause mortality. Predictors of HFrehospitalization were LVEF, MR and PVL at last echocardiographic follow-up. The majority of patients were in NYHA class I or II and showed mild/trivial paravalvular leak throughout follow-up.Mean pressure gradients remained stable over time. The overall crude cumulative incidences of structural valve deterioration and bioprosthetic valve failure were 3.6% and 2.5% respectively.Conclusions: although overall mortality was high in this elderly patient cohort, the CoreValve bioprosthesis showed excellent durability at 7-year follow-up.
Mitral regurgitation is the most common valve disorder in the Western world, and although surgery is the established therapeutic gold standard, percutaneous transcatheter mitral interventions are gaining acceptance in selected patients who are inoperable or at an exceedingly high surgical risk. For such patients, multidetector computed tomography (MDCT) can provide a wealth of valuable morphological and functional information in the preoperative setting. Our aim is to give an overview of the MDCT image acquisition protocols, post-processing techniques, and imaging findings with which radiologists should be familiar to convey all relevant information to the Heart Team for successful treatment planning.
AimsThe aim of this study was to minimize the procedure, and reduce the length of hospital stay (LoS) is the future objective for transcatheter aortic valve replacement (TAVI).Aims of the study are to identify procedural and electrocardiographical predictors of fast-track discharge in patients who underwent TAVI.MethodsPatients treated with TAVI included in the One Hospital ClinicalService project were categorized according to the LoS. ‘Fast-Track’ population, with a postprocedural LoS less than or equal to 3 days, was compared with the ‘Slow-Track’ population with a postprocedural LoS greater than 3 days.ResultsOne thousand five hundred and one patients were collected. Despite single baseline characteristics being almost similar between the two groups, Slow-Track group showed a higher surgical risk (P < 0.001). Patients in the Slow-Track group were more frequently treated with general anaesthesia (P = 0.002) and less frequently predilated (P < 0.001) and received a lower amount of contrast media. No difference between Slow-Track and Fast-Track patients was observed at 30 days in death and in cardiovascular rehospitalization.In the multivariable analysis, STS score of at least 4% [odds ratio (OR): 1.64; P = 0.01], general anaesthesia (OR: 2.80; P = 0.03), predilation (OR: 0.45; P < 001), NYHA 3–4 at baseline (OR: 1.65; P = 0.01), AVB I/LBBB/RBBB onset (OR: 2.41; P < 0.001) and in-hospital new PM (OR: 2.63; P < 0.001) were independently associated with a higher probability of Slow-Track.ConclusionFast-Track patients were safely discharged home showing no difference in clinical outcomes after discharge up to 30 days compared with the Slow-Track group. The STS score, general anaesthesia, NYHA 3--4 at baseline, in-hospital onset of conduction disturbances and new PM implantation after TAVI turned out to be predictors of Slow-Track.
OBJECTIVES
This study aimed to assess the feasibility and safety of conducting an entire transcatheter aortic valve replacement (TAVR) program by using percutaneous techniques only.
BACKGROUND
Surgically assisted transthoracic TAVR has been reported to be associated with more complications and longer hospital stays.
METHODS
During 2019, all TAVR at a single center were performed by standard transfemoral (TF), intravascular lithotripsy‐assisted TF, transaxillary (TAx), or transcaval approach using percutaneous techniques only. No patients were denied TAVR because of access. Procedural and clinical endpoints were categorized using Valve Academic Research Consortium‐2 criteria.
RESULTS
In total, 306 consecutive TAVR patients were enrolled (mean age 78.9 ± 7.2 years). Most patients were treated by TF approach (94.8%)—of these, nine (2.9%) were pre‐treated with intravascular lithotripsy. A percutaneous TAx and transcaval approach were used in 12 (3.9%) and four patients (1.3%), respectively. There were no procedural deaths and one peri‐procedural stroke. Valve performance was satisfying in 298 patients (97.4%); six patients had a moderate aortic regurgitation and two patients had a mean gradient ≥20 mmHg following valve‐in‐valve procedure. The 30‐day major vascular complication and major bleeding rate was 2.3% and 3.9%, respectively. A new permanent pacemaker was implanted in 41 patients (13.4%). Of all patients, 81% were discharged within two days post‐TAVR, including 11 out of 12 TAx patients and all transcaval cases.
CONCLUSIONS
A fully percutaneous TAVR program is feasible and safe with favorable immediate and early clinical outcomes and allowing a short hospital stay.
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