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Transcatheter Aortic Valve Implantation and Morbidity andMortality-Related Factors: a 5-Year Experience in Brazil

View Article: PubMed Central - PubMed

ABSTRACT

Background: Transcatheter aortic valve implantation has become an option forhigh-surgical-risk patients with aortic valve disease.

Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheteraortic valve implantation.

Methods: Prospective cohort study of transcatheter aortic valve implantation casesfrom July 2009 to February 2015. Analysis of clinical and proceduralvariables, correlating them with in-hospital and one-year mortality.

Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heartvalve implantation; of these, 49% were women, 131 (96.3%) had aorticstenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prostheticvalve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%).The baseline orifice area was 0.67 ± 0.17 cm2 and the meanleft ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with anSTS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expandingin 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%;in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Bloodtransfusion (relative risk of 54; p = 0.0003) and pulmonary arterialhypertension (relative risk of 5.3; p = 0.036) were predictive ofin-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p =0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) werepredictive of 1-year mortality. At 30 days, 97% of patients were in NYHAfunctional class I/II; at one year, this figure reached 96%.

Conclusion: Transcatheter aortic valve implantation was performed with a high successrate and low mortality. Blood transfusion was associated with higherin-hospital and one-year mortality. Peak C-reactive protein was associatedwith one-year mortality.

No MeSH data available.


One-year survival Kaplan-Meier curve.
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f2: One-year survival Kaplan-Meier curve.

Mentions: Accumulated overall one-year mortality was 18.3% (20/109) (Figure 2), of which cardiovascular mortality accounted for sevencases (two sudden deaths, one AMI for stent thrombosis, one for heart failure, twofor hemorrhagic stroke and one for LV perforation When the subgroup of one-yeardeath was compared to the group of survivors, we observed that the first groupshowed, among the pre-procedural characteristics, higher rates of chronicobstructive pulmonary disease (30% vs 6.7%; p = 0.008); logistic euroSCORE [31%(16-42) vs 19% (10-28); p = 0.006]; STS score [22% (12-36) vs 8% (4-19); p =0.0005]; baseline CRP [1.7 mg/dL (0.2-2.3) vs 0.30 mg/dL (0.2-1.0); p = 0.01];direct TAVI (40% vs 15.7%; p = 0.02); post-TAVI blood transfusion (60% vs 16.9%;p=0.0002); peak CRP [13.1 mg/dL (8.2-16.2) vs 7.5 mg/dL (4.4-10.6); p = 0.001]; andlower rates of general anesthesia (55% vs 78.7%; p = 0.032) and TEE (50% vs 77.5%;p=0.016). According to the logistic regression analysis, post-TAVI blood transfusion(p = 0.0009) and peak CRP (p = 0.013) were independent predictors of one-year death(Table 5).


Transcatheter Aortic Valve Implantation and Morbidity andMortality-Related Factors: a 5-Year Experience in Brazil
One-year survival Kaplan-Meier curve.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940151&req=5

f2: One-year survival Kaplan-Meier curve.
Mentions: Accumulated overall one-year mortality was 18.3% (20/109) (Figure 2), of which cardiovascular mortality accounted for sevencases (two sudden deaths, one AMI for stent thrombosis, one for heart failure, twofor hemorrhagic stroke and one for LV perforation When the subgroup of one-yeardeath was compared to the group of survivors, we observed that the first groupshowed, among the pre-procedural characteristics, higher rates of chronicobstructive pulmonary disease (30% vs 6.7%; p = 0.008); logistic euroSCORE [31%(16-42) vs 19% (10-28); p = 0.006]; STS score [22% (12-36) vs 8% (4-19); p =0.0005]; baseline CRP [1.7 mg/dL (0.2-2.3) vs 0.30 mg/dL (0.2-1.0); p = 0.01];direct TAVI (40% vs 15.7%; p = 0.02); post-TAVI blood transfusion (60% vs 16.9%;p=0.0002); peak CRP [13.1 mg/dL (8.2-16.2) vs 7.5 mg/dL (4.4-10.6); p = 0.001]; andlower rates of general anesthesia (55% vs 78.7%; p = 0.032) and TEE (50% vs 77.5%;p=0.016). According to the logistic regression analysis, post-TAVI blood transfusion(p = 0.0009) and peak CRP (p = 0.013) were independent predictors of one-year death(Table 5).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Transcatheter aortic valve implantation has become an option forhigh-surgical-risk patients with aortic valve disease.

Objective: To evaluate the in-hospital and one-year follow-up outcomes of transcatheteraortic valve implantation.

Methods: Prospective cohort study of transcatheter aortic valve implantation casesfrom July 2009 to February 2015. Analysis of clinical and proceduralvariables, correlating them with in-hospital and one-year mortality.

Results: A total of 136 patients with a mean age of 83 years (80-87) underwent heartvalve implantation; of these, 49% were women, 131 (96.3%) had aorticstenosis, one (0.7%) had aortic regurgitation and four (2.9%) had prostheticvalve dysfunction. NYHA functional class was III or IV in 129 cases (94.8%).The baseline orifice area was 0.67 ± 0.17 cm2 and the meanleft ventricular-aortic pressure gradient was 47.3±18.2 mmHg, with anSTS score of 9.3% (4.8%-22.3%). The prostheses implanted were self-expandingin 97% of cases. Perioperative mortality was 1.5%; 30-day mortality, 5.9%;in-hospital mortality, 8.1%; and one-year mortality, 15.5%. Bloodtransfusion (relative risk of 54; p = 0.0003) and pulmonary arterialhypertension (relative risk of 5.3; p = 0.036) were predictive ofin-hospital mortality. Peak C-reactive protein (relative risk of 1.8; p =0.013) and blood transfusion (relative risk of 8.3; p = 0.0009) werepredictive of 1-year mortality. At 30 days, 97% of patients were in NYHAfunctional class I/II; at one year, this figure reached 96%.

Conclusion: Transcatheter aortic valve implantation was performed with a high successrate and low mortality. Blood transfusion was associated with higherin-hospital and one-year mortality. Peak C-reactive protein was associatedwith one-year mortality.

No MeSH data available.