Initial Experience of Two National Centers in Transcatheter Aortic Prosthesis Implantation

Abstract

BackgroundTranscatheter aortic valve implantation is an effective alternative to surgical treatment of severe aortic stenosis in patients who are inoperable or at high surgical risk.ObjectivesTo report the immediate and follow-up clinical and echocardiographic results of the initial experience of transcatheter aortic valve implantation.MethodsFrom 2009 June to 2013 February, 112 patients underwent transcatheter aortic valve implantation.ResultsMean age was 82.5 ± 6.5 years, and the logistic EuroSCORE was 23.6 ± 13.5. Procedural success was 84%. After the intervention, a reduction in the mean systolic gradient was observed (pre: 54.7 ± 15.3 vs. post: 11.7 ± 4.0 mmHg; p < 0.01). Cerebrovascular accidents occurred in 3.6%, vascular complications in 19% and permanent pacemaker was required by 13% of the patients. Thirty-day mortality and at follow-up of 16 ± 11 months was 14% and 8.9% respectively. The presence of chronic obstructive pulmonary disease was the only predictor of mortality at 30 days and at follow-up. During follow up, aortic valve area and mean systolic gradient did not change significantly.ConclusionsTranscatheter aortic valve implantation is an effective and safe procedure for the treatment of aortic stenosis in high-surgical risk or inoperable patients. The presence of chronic obstructive pulmonary disease was the only independent predictor of mortality identified both in the first month post-intervention and at follow-up.

The relationship between chronic obstructive pulmonary disease and transcatheter aortic valve implantation—A systematic review and meta‐analysis

“…A total of 1110 citations were identified, and 85 full‐length studies remained after carefully screening the title and abstract. A total of 28 studies, incorporating 51,530 patients, met our inclusion and exclusion criteria after reading the full text. Although there were two studies that had overlapping data, they reported on different clinical aspects that we wanted to address.…”

“…The prevalence of COPD ranged from 12.5% to 43.4% in patients who underwent TAVI . Several large registries reported that the burden of COPD varied from 22.8% to 28.0% , but the PARTNER trial reported the prevalence of COPD was 43.4% .…”

Predictive role of Selvester QRS score in patients undergoing transcatheter aortic valve replacement

“…After adjustment for multivariate analysis, no clinical factors were correlated with outcomes, except for dyslipidemia, which may suggest that this comorbidity is related both to AS acceleration and its severity, as reported by others 39‐41 . Thus, in our population, factors that have been classically correlated with mortality such as chronic kidney disease and COPD did not maintain significance after adjustments 3,4,30,42,43 . Sinning et al 7 reported that a severe increase in sPAP measured preoperatively was associated with an increased risk of death (hazard ratio [HR], 3.3, p = .003) and a higher incidence of comorbidities such as peripheral vascular arteriopathy, CAD, chronic kidney disease, and atrial fibrillation.…”

“…[39][40][41] Thus, in our population, factors that have been classically correlated with mortality such as chronic kidney disease and COPD did not maintain significance after adjustments. 3,4,30,42,43 Sinning et al 7 reported that a severe increase in sPAP measured preoperatively was associated with an increased risk of death (hazard ratio [HR],…”