Abstract 14008: Can We Predict Which Patients Will Benefit Most From a Transcatheter Aortic Valve Implantation ?
Background: Transcatheter Aortic Valve Implantation (TAVI) has recently emerged as an attractive alternative for treating patients with severe aortic stenosis (AS) who are not candidate for conventional aortic valve replacement. Because TAVI prosthesis are quite expensive and not every patient in whom they are implanted benefit from the procedure, we aimed at investigating if any preimplantation patient's characteristics would help predicting an unfavorable outcome after TAVI.
Methods: Between January 2008 and May 2010, 70 consecutive patients with severe AS (31 women; mean age: 84 ± 5years) underwent TAVI using the Edwards-Sapien valve. The clinical outcome was assessed at 1 and 6 months after implantation. Overall and cardiovascular survivals were computed. Logistic and Cox regression analyses were used to identify independent predictors of clinical improvement and/or outcome.
Results: 18 patients died during a mean follow-up of 8 months. At 20 months, mean overall survival was 60%. Among the 58 patients who survived up to the 6 months follow-up, 45 were in NYHA class II or less and reported significant clinical improvement, whereas 13 were still in NYHA class III–IV and reported no significant clinical improvement. Cox survival analysis identified age (p<0.026) and renal dysfunction (p<0.029) as independant predictors for mortality. Logistic regression analysis identified LV ejection fraction (p<0.001) and chronic obstructive pulmonary disease (COPD, p=0.078) as being associated with functional improvement at 6 months (see Table).
Conclusion: In high risk patients undergoing TAVI, advanced age and renal dysfunction are associated with an increased risk of death, whereas pre-TAVI LV dysfunction and COPD identify patients who are more likely to remain symptomatic after the procedure.
- © 2010 by American Heart Association, Inc.