Morbidity and mortality of nonagenarians undergoing CoreValve implantation

BMC Cardiovascular Disorders

Research Article

Stephan Kische¹  Henrik Schneider¹  Gökmen R Turan¹  Ilkay Bozdag-Turan¹  Lylia Paranskaya¹  Jasmin Ortak¹  Ibrahim Akin¹  Ralf Birkemeyer¹  Tim C Rehders¹  Dimitar Divchev¹  Hüseyin Ince¹  Christoph A Nienaber¹  Gunther Kundt² 

[1] Heart Center Rostock, Department of Internal Medicine I, University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany;Institute for Biostatistics and Information in Medicine and Ageing Research, Rostock School of Medicine, University Hospital Rostock, Ernst-Heydemann-Str 6, 18057, Rostock, Germany;

关键词: CoreValve;    Aortic stenosis;    Nonagenarian;    Surgery;    TAVI;   

DOI  :  10.1186/1471-2261-12-80

 received in 2012-04-16, accepted in 2012-09-20,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundNonagenarians are mostly denied from different therapeutic strategies due to high comorbidity index and risk-benefit calculation. We present the results of nonagenarians with high comorbidity index not eligible for conventional aortic valve surgery undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve system.MethodsOur retrospective analysis include baseline parameters, procedural characteristics, morbidity, mortality as well as twelve-lead surface ECG and echocardiographic parameters which were revealed preinterventionally, at hospital discharge and at 30-day follow-up. Clinical follow-up was performed 6 months after TAVI.ResultsOut of 158 patients 11 nonagenarians with a mean age of 92.6 ± 1.3 years suffering from severe aortic valve stenosis and elevated comorbidity index (logistic EuroSCORE of 32.0 ± 9.5%, STS score 25.3 ± 9.7%) underwent TAVI between January 2008 and January 2011 using the third-generation percutaneous self-expanding CoreValve prosthesis. Baseline transthoracic echocardiography reported a mean aortic valve area (AVA) of 0.6 ± 0.2 cm2 with a mean and peak pressure gradient of 60.2 ± 13.1mmHg and 91.0 ± 27.4mmHg, respectively. The 30-day follow up all cause and cardiovascular mortality was 27.3% and 9.1%, respectively. One major stroke (9.1%), 2 pulmonary embolisms (18.2%), 1 periprocedural (9.1%) and 1 (9.1%) spontaneous myocardial infarction occured. Life-threatening or disabling bleeding occurred in 2 cases (18.2%), and minor bleeding in 7 cases (63.6%). Mean severity of heart failure according to NYHA functional class improved from 3.2 ± 0.8 to 1.36 ± 0.5 while mean AVA increased from 0.6 ± 0.2cm2 to 1.8 ± 0.2cm2. At 6-months follow-up 8 patients (72.7%) were alive without any additional myocardial infarction, pulmonary embolism, bleeding, or stroke as compared to 30-day follow-up.ConclusionOur case series demonstrate that even with elevated comorbidity index, clinical endpoints and valve-associated results are relatively favorable in nonagenarians treated with CoreValve.

【 授权许可】

CC BY   
© Akin et al.; licensee BioMed Central Ltd. 2012