Abstract 21009: Mid-term outcomes of Medtronic-Corevalve Transcatheter Aortic Valve Implantation: Follow-up to 4 years
Background: Transcatheter Aortic Valve Implantation(TAVI) has yielded favourable outcomes at 1 year follow-up in multicenter series. Limited data exists for results beyond this time-frame.
Methods: A consecutive series of patients TAVI with at least 1 year clinical follow-up was studied. Valve deterioration of stenotic type was defined as an increase in mean aortic valve gradient at follow-up to greater or equal to twice that seen on pre-discharge echocardiography. Valve deterioration of regurgitant type was defined as an increase in aortic regurgitation(AR) grade by 1 or more.
Results: Fifty eight patients underwent attempted TAVI with the Medtronic-Corevalve device between December 2005 and April 2009. Mean age was 81.4 ± 6.2 years , mean logistic EuroSCORE 23.4 ± 16.1 and 51.7 % were females. Procedural success was 96.6%. Mortality was 13.8% at 30 days, 27.4% at 1 year, 53.6% at 2 years and 63.6% at 3 years. There were no valve related deaths seen, and no cardiac deaths beyond 30 days. Two unexplained deaths at home occurred at 104 and 934 days post-procedure. Echocardiographic follow-up beyond discharge of successful implants was available in 94% at a median of 310 days(maximum 1461 days). Valve deterioration was seen in 5 cases(8.6%). It was of stenotic type in 2 cases, seen at 313 and 466 days post- procedure, with mean aortic valve gradient increasing from 5 to 15mmHg in one case and from 7 to 17mmHg in the other. Valve deterioration was of regurgitation type in 3 cases, seen at a median of 444 days(range 168–721 days); this was from trivial AR to grade 2 in 1 and from grade 1 to 2 in 2 cases, with no increase in left ventricular dimension. AR of grade 2 or more was seen in 18.2% pre-discharge and 14% at follow-up(p=0.91). Paradoxically, paravalvular AR post procedure improved by at least 1 grade in 4 patients(grade 2 to grade 1 in all cases). AVA was 1.70 ± 0.40 cm2 post-procedure and 1.61 ± 0.37 cm2 at follow-up(p=0.23).
Conclusions: TAVI is associated with excellent bioprosthetic function acutely which is sustained at follow-up. Mortality is incremental and related to extensive comorbidity.
- © 2010 by American Heart Association, Inc.