Premium
Predictors and outcomes after transcatheter aortic valve implantation using different approaches according to the valve academic research consortium definitions
Author(s) -
Seiffert Moritz,
Schnabel Renate,
Conradi Lenard,
Diemert Patrick,
Schirmer Johannes,
Koschyk Dietmar,
Linder Matthias,
Kersten Jan F.,
Grosser Andrea,
Wilde Sandra,
Blankenberg Stefan,
Reichenspurner Hermann,
Baldus Stephan,
Treede Hendrik
Publication year - 2013
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.24751
Subject(s) - medicine , hazard ratio , cardiology , myocardial infarction , ejection fraction , aortic valve , surgery , heart failure , confidence interval
Objectives We report the results of a large single‐center study evaluating predictors and outcomes after transcatheter aortic valve implantation (TAVI) with different devices and access routes according to the Valve Academic Research Consortium (VARC). Background The widespread adoption of TAVI warrants a systematic analysis of outcomes. Only few comprehensive data exist comparing different approaches as selected by a heart team. Methods TAVI was performed in 326 consecutive patients (mean age 80.6 ± 7.1 years, 55.5% female) at high risk for surgery with balloon‐expandable and self‐expanding devices through transfemoral or transapical access. Data were analyzed according to VARC endpoints; predictors of mortality were identified. Results All‐cause mortality was 10.1% (30 days) and 29.9% (1 year) overall and comparable with regard to valve or access choice ( P = 0.295) despite different risk profiles at baseline. Device success and 30‐day safety endpoints were achieved in 87.1 and 21.2%. Myocardial infarction [hazard ratio (HR) 6.52], stage‐2 and −3 acute kidney injury (HR 2.52 and 6.80) and major access site complications (HR 1.96) were independent predictors of 1‐year all‐cause mortality. Device success had a protective effect (HR 0.58). Baseline predictors included body mass index <20 kg/m 2 (HR 3.20), NYHA class IV (HR 1.87), left ventricular ejection‐fraction <30% (HR 2.30), higher STS‐PROM scores (HR 1.05 per percent), and age (group 75–85 years, HR 0.47). Conclusions Comparable results were achieved with different devices and access routes in a heart team approach. Baseline and perioperative predictors of all‐cause mortality were identified, contributing to the refinement of patient and device selection criteria for TAVI. © 2012 Wiley Periodicals, Inc.