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1/2021
vol. 17
abstract:
Original paper
Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis
Janusz Konstanty-Kalandyk
3
,
1.
Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
2.
Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
3.
Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
4.
Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
5.
Nonivasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
6.
Department of Anaesthesiology and Intensive Therapy, John Paul II Hospital, Krakow, Poland
7.
Jagiellonian University Medical College, Institute of Cardiology, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital, Krakow, Poland
8.
2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
9.
Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
Adv Interv Cardiol 2021; 17, 1 (63): 68–74
Online publish date: 2021/03/27
Introduction
Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access.
Aim: To assess early- and mid-term clinical outcomes after TA-TAVI.
Material and methods
Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed.
Results
Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0–84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6–27.7) and 4.8% (3.3–8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15–8.76: p = 0.026; RR for AVA per 0.1 cm2 1.28, 95% CI: 1.03–1.55: p = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94–0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01–1.17: p = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02–1.16: p = 0.011).
Conclusions
Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.
keywords:
aortic stenosis, high-risk patients, outcomes, transcatheter aortic valve implantation, transapical
Summary
Transapical transcatheter aortic valve implantation in patients who are not suitable for a transfemoral approach gives a good hemodynamic result with significant clinical improvement History of cerebrovascular event, impaired renal function, aortic valve area, increased NT-proBNP and right ventricular systolic pressure level may be associated with higher mortality at the 12-month follow-up
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