Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation

• Published in: Journal of clinical medicine Vol. 10; no. 19; p. 4563
• Main Authors: Avvedimento, Marisa, Franzone, Anna, Leone, Attilio, Piccolo, Raffaele, Castiello, Domenico Simone, Ilardi, Federica, Mariani, Andrea, Esposito, Roberta, Iapicca, Cristina, Angellotti, Domenico, Scalamogna, Maria, Santoro, Ciro, Di Serafino, Luigi, Cirillo, Plinio, Esposito, Giovanni
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-09-2021; MDPI
• Subjects: Classification; Clinical medicine; Clinical outcomes; Endocarditis; Heart attacks; Hypertension; Mortality; Pacemakers; Patients; Pulmonary arteries; transcatheter aortic valve implantation; mortality; staging; cardiac damage
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10194563

(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (
= 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.