The reliability of the variables in the national Swedish Cardiac Surgery Registry was excellent. Thus, the registry is a valuable source of data for quality studies and research. Some EuroSCORE II variables require improved and stricter definitions to obtain uniform reporting and high validity.
Objectives. To describe short-term clinical and echocardiography outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). To explore patient selection criteria for treatment with TAVI.Design. TAVI patients (n=45) were matched to SAVR patients (n=45) with respect to age within ±10 years, sex and systolic left ventricular function.Results. TAVI patients were older, 82±8 vs. 78±5 years (p=0.005) and they had higher logEuroSCORE, 16±11% vs. 8±4% (p<0.001). There were no significant differences in 30 day mortality, stroke and myocardial infarction. TAVI patients received less erythrocyte (53% vs. 78%, p=0.03) and thrombocyte (7% vs. 27%, p=0.02) transfusions. Postoperative atrial fibrillation was less common (18% vs. 60%, p<0.001) in the TAVI group. Paravalvular regurgitation was more common in TAVI patients (87% vs. 0%, p<0.001) and 27% had access site complications. Aortic transvalvular velocity was 2.3±0.4 m/s vs. 2.6±0.5 m/s (p=0.002) and mean valve pressure gradient was 12±4 mmHg vs. 15±5 mmHg, (p=0.01) in the TAVI and SAVR groups respectively. Twenty-nine (64%) of the TAVI patients had logEuroSCORE <15%.Conclusions. Both TAVI and SAVR have good short term clinical outcome with excellent hemodynamic result. In clinical practice, factors other than high logEuroSCORE play an important role in patient selection for TAVI.
We present a user-friendly echo-guided method to facilitate fluoroscopy adjustment during transcatheter aortic valve implantation. In our series, the amounts of contrast medium and radiation have been significantly reduced, with a concomitant reduction in detrimental effects on renal function in the early postoperative phase.
Background: Impaired respiratory function is believed to be a risk factor for transapical aortic valve implantation (TA-AVI). The purpose of this study was to investigate the incidence, predictors and impact of acute and chronic respiratory failure (ARF and CRF) on procedural success and outcome. Methods: 350 consecutive 'high-risk' patients, age 81.8 Ϯ 6.4 years, 66.3% female, were included during a 4-year period. Preoperative estimated FEV1 was 91.9 Ϯ 33.6%. Mean logistic EuroSCORE was 31.0 Ϯ 15.9% and mean STS-Score 12.0 Ϯ 7.7%. An uni-and multivariate logistic regression analysis was performed. Results: Regarding the postoperative respiratory outcome, ARF occurred in 14.9% and interstitial lung disease (OR ϭ 23.40, p ϭ 0.01), transfusion Ͼ 4 RBC units (OR ϭ 15.35, p Ͻ 0.001), brief reactive psychosis (OR ϭ 8.39, p ϭ 0.001), age Ն 80 yrs (OR ϭ 3.66, p ϭ 0.035) and vital capacity Յ 60% (OR ϭ 3.23, p ϭ 0.025) were independent risk factors for this event. Postoperative re-intubation was required in 17.1%. Vital capacity Յ 60% (OR ϭ 2.94, p ϭ 0.046) and transfusion Ͼ 4 RBC units (OR ϭ 16.00, p Ͻ 0.001) were independent risk factors for CRF. Short-term and long-term survival was explicitly lower in the ARF, CRF and re-intubation groups (p Ͻ 0.001 each). Conclusions: Interstitial lung disease, age Ն 80 yrs and vital capacity Յ 60% are preoperative risk factors for impaired respiratory outcome. Further studies will define if the same risk factors can be expected using a transfemoral approach.
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