Facchin, Michela (2018) Clinical and Hemodynamic Results after Transcatheter Aortic Valve implantation (TAVI): Early and Late (10-year) follow-up. [Ph.D. thesis]
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Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe symptomatic aortic stenosis (AS) considered inoperable or at high surgical risk. More recently, TAVI has been performed also to lower risk patients based on the Heart Team decision. Few studies have studied interaction between surgical risk categories and outcomes.
Aim of the study
To analyze safety and efficacy (VARC-2 defined) TAVI treated patients as function of different preoperative risk. To assess independent predictors of death.
Four-hundred-eighty-two patients who underwent TAVI in our center between 2007 and 2017 were included in the study. According to Society of Thoracic Surgeons (STS) score and to other parameters, all the patients were retrospectively stratified into 4 groups: prohibitive (contraindications to aortic valve replacement, n = 124), high (STS > 8, n = 131), intermediate (4 ≤ STS ≤ 8, n = 112) and low (STS < 4, n = 115) risk. Early, 1-year and long-term outcomes have been evaluated in those 4 groups according the VARC 2 criteria.
The TAVI procedure resulted to be safe because of low mortality rate throughout all risk groups. The lowest 30-days mortality rate was observed in low and prohibitive-risk patients (p=0.048). In the low risk group, in-hospital mortality was 0%. The results were similar at 1-year of follow-up, with a mortality rate of 6% and 7% in low- and prohibitive-risk patients vs 21% and 19% in intermediate- and high-risk groups, (p<0.008). At 5-year of follow-up the mortality rate was 52% and it appeared to be lower only in low-risk patients at long-term follow-up. Independent predictors of mortality were pre-procedural congestive heart failure (CHF), neoplastic disease, pre-procedural-creatinine, post-procedural major or life threatening bleeding and post-procedural acute kidney injury (AKI). Implanted prosthesis performed well with stable hemodynamic results over time and rare dysfunction (2.1%).
In our study population, TAVI was safe and effective, with low rates of mortality and adverse events regardless of the surgical risk. At longer follow-up mortality rate was significantly lower in low-risk patients. Pre-procedural CHF, neoplastic diseases, pre-procedural creatinine, post-procedural severe bleedings and post-procedural AKI were independent predictors of mortality. Transcatheter heart valves (THV) performance after the procedure was excellent and stable over time with low rate of late prosthesis dysfunction. Further studies should be addressed to confirm the promising long-term results among low-risk patients and the long-term durability of THV.
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