Author/Authors :
Rodés-Cabau، نويسنده , , Josep and Webb، نويسنده , , John G. and Cheung، نويسنده , , Anson and Ye، نويسنده , , Jian and Dumont، نويسنده , , Eric and Feindel، نويسنده , , Christopher M. and Osten، نويسنده , , Mark and Natarajan، نويسنده , , Madhu K. and Velianou، نويسنده , , James L. and Martucci، نويسنده , , Giuseppe and DeVarennes، نويسنده , , Benoît and Chisholm، نويسنده , , Robert and Peterson، نويسنده , , Mark D. and Lichtenstein، نويسنده , , Samuel V. and Nietlispach، نويسنده , , Fabian and Doyle، نويسنده , , Daniel and DeLarochellière، نويسنده , , Robert and Teoh، نويسنده , , Kevin and Chu، نويسنده , , Victor and Dancea، نويسنده , , Adrian and Lachapelle، نويسنده , , Kevin and Cheema، نويسنده , , Asim and Latter، نويسنده , , David and Horlick، نويسنده , , Eric، نويسنده ,
Abstract :
Objectives
m 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.
ound
ew 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.
s
utive 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.
s
l 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.
sions
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.
