Transcatheter Aortic Valve Implantation for the Treatment of Severe Symptomatic Aortic Stenosis in Patients at Very High or Prohibitive Surgical Risk Acute and Late Outcomes of the Multicenter Canadian Experience

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:55

Article

Rodes-Cabau, Josep¹  Webb, John G.²  Cheung, Anson²  Ye, Jian²  Dumont, Eric¹  Feindel, Christopher M.³  Osten, Mark³  Natarajan, Madhu K.⁴  Velianou, James L.⁴  Martucci, Giuseppe⁵  DeVarennes, Benoit⁵  Chisholm, Robert⁶  Peterson, Mark D.⁶  Lichtenstein, Samuel V.²  Nietlispach, Fabian²  Doyle, Daniel¹  DeLarochelliere, Robert¹  Teoh, Kevin⁴  Chu, Victor⁴  Dancea, Adrian⁵  Lachapelle, Kevin⁵  Cheema, Asim⁶  Horlick, Eric³ 

[1] Univ Laval, Quebec Heart & Lung Inst, Quebec City, PQ G1V 4G5, Canada

[2] Univ British Columbia, St Pauls Hosp, Vancouver, BC V5Z 1M9, Canada

[3] Univ Toronto, Toronto Gen Hosp, Toronto, ON M5G 1L7, Canada

[4] McMaster Univ, Hamilton Gen Hosp, Hamilton, ON, Canada

[5] McGill Univ, Royal Victoria Hosp, Montreal, PQ H3A 1A1, Canada

[6] Univ Toronto, St Michaels Hosp, Toronto, ON M5B 1W8, Canada

关键词: transapical;    transcatheter aortic valve implantation;    transfemoral;    valves;   

DOI  :  10.1016/j.jacc.2009.12.014

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was: 1) to evaluate the acute and late outcomes of a transcatheter aortic valve implantation (TAVI) program including both the transfemoral (TF) and transapical (TA) approaches; and 2) to determine the results of TAVI in patients deemed inoperable because of either porcelain aorta or frailty. Background Very few data exist on the results of a comprehensive TAVI program including both TA and TF approaches for the treatment of severe aortic stenosis in patients at very high or prohibitive surgical risk. Methods Consecutive patients who underwent TAVI with the Edwards valve (Edwards Lifesciences, Inc., Irvine, California) between January 2005 and June 2009 in 6 Canadian centers were included. Results A total of 345 procedures (TF: 168, TA: 177) were performed in 339 patients. The predicted surgical mortality (Society of Thoracic Surgeons risk score) was 9.8 +/- 6.4%. The procedural success rate was 93.3%, and 30-day mortality was 10.4% (TF: 9.5%, TA: 11.3%). After a median follow-up of 8 months (25th to 75th interquartile range: 3 to 14 months) the mortality rate was 22.1%. The predictors of cumulative late mortality were peri-procedural sepsis (hazard ratio [HR]: 3.49, 95% confidence interval [CI]: 1.48 to 8.28) or need for hemodynamic support (HR: 2.58, 95% CI: 1.11 to 6), pulmonary hypertension (PH) (HR: 1.88, 95% CI: 1.17 to 3), chronic kidney disease (CKD) (HR: 2.30, 95% CI: 1.38 to 3.84), and chronic obstructive pulmonary disease (COPD) ( HR: 1.75, 95% CI: 1.09 to 2.83). Patients with either porcelain aorta (18%) or frailty (25%) exhibited acute outcomes similar to the rest of the study population, and porcelain aorta patients tended to have a better survival rate at 1-year follow-up. Conclusions A TAVI program including both TF and TA approaches was associated with comparable mortality as predicted by surgical risk calculators for the treatment of patients at very high or prohibitive surgical risk, including porcelain aorta and frail patients. Baseline (PH, COPD, CKD) and peri-procedural (hemodynamic support, sepsis) factors but not the approach determined worse outcomes. (J Am Coll Cardiol 2010; 55: 1080-90) (C) 2010 by the American College of Cardiology Foundation

【 授权许可】

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