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.
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.
Consecutive patients who underwent TAVI with the Edwards valve (Edwards Lifesciences,
Inc., Irvine, California) between January 2005 and June 2009 in 6 Canadian centers
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.
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.
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc.
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