Transcatheter aortic valve implantation using transfemoral/transsubclavian or transapical approach: 30-day follow-up of the initial 30 patients

• Published in: Kardiologia polska Vol. 69; no. 2; p. 105
• Main Authors: Witkowski, Adam, Dąbrowski, Maciej, Chmielak, Zbigniew, Demkow, Marcin, Stępińska, Janina, Juraszyński, Zbigniew, Kuśmierski, Krzysztof, Michałek, Piotr, Michałowska, Ilona, Dziekiewicz, Mirosław, Sitkowska-Rysiak, Ewa, Wolski, Piotr, Księżycka, Ewa, Czerwińska, Katarzyna, Hryniewiecki, Tomasz, Chojnowska, Stefania Lidia, Rużyłło, Witold
• Format: Journal Article
• Language: English
• Published: Poland 2011
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - surgery; Cardiac Catheterization; Female; Follow-Up Studies; Heart Valve Prosthesis Implantation - methods; Humans; Male; Risk Factors; Severity of Illness Index; Treatment Outcome
• ISSN: 1897-4279

Transcatheter aortic valve implantation (TAVI) is a new method for the treatment of aortic stenosis (AS).
To evaluate early results of TAVI using transfemoral/transsubclavian approach (TFA/TSA) or transapical approach (TAA) in patients with severe AS and high risk for surgical aortic valve replacement.
Between January 2009 and May 2010, 30 high-risk patients underwent TAVI. The primary treatment option was TFA, and TAA was used if contraindications to TFA were present; one patient underwent the procedure using TSA. Reasons for selecting TAA were as follows: small diameter (<7 mm) and/or severe calcification of the iliofemoral arteries, peripheral atherosclerosis, "porcelain" aorta and a horizontal course of the ascending aorta. Edwards-Sapien or CoreValve devices were used in all cases, and procedures were performed without the use of cardiopulmonary bypass in a cardiac catheterisation laboratory.
Mean patient age was 82.46 ± 5.79 years, mean NYHA class was 3.23 ± 0.41, and predicted mean surgical mortality using logistic Euroscore was 29.18 ± 16.9% (22.72 ± 12.07% in the TFA/TSA group vs 34.6 ± 15.4% in the TAA group; p = 0.031). Eleven patients were treated using TAA. The valve was implanted successfully in 96% of patients. Inhospital mortality was 3.3%. Mean 30-day mortality was 6.6% in the entire cohort, 0% in the TFA/TSA group and 18% in the TAA group. There were no cases of periprocedural myocardial infarction (MI), cardiogenic shock, stroke/transient ischaemic attack, or need for cardiopulmonary resuscitation. One patient died suddenly three weeks after the procedure; except for this case, there were no major adverse cardiovascular events (MACCE: MI, cerebrovascular accident, re-do procedure) at 30-day follow-up. The TAVI was associated with a significant reduction in the mean maximal aortic gradient in both groups (from 99.6 ± 22.07 mm Hg to 21.83 ± 9.38 mm Hg post-procedure and to 23.25 ± 9.22 mm Hg at 30-day follow up), with no cases of severe aortic valve regurgitation. The NYHA class at 30 days improved from 3.23 ± 0.41 to 1.72 ± 0.52 (p = 0.03).
Our results demonstrate lower 30-day complication rate and mortality in the TFA/TSA group. The availability of several techniques of valve implantation in the group of non-surgical patients with severe AS potentially broadens the patient population with indications for this treatment.