Abstract 12876: Trans-Apical Aortic Valve Implantation in the Real World: Results of 566 Cases From a National Registry
Background. Objective of this study was to assess clinical and hemodynamic outcomes of trans-apical aortic valve implantation (TA-TAVI) in a large cohort of patients.
Methods. We analyzed data from 566 high-risk or inoperable patients who underwent TA-TAVI from April 2008 through May 2011 in 20 cardiac surgery centers. Data were prospectively collected in our National Registry of Trans-Apical Aortic Valve Implantation. Outcomes were also analyzed according to the impact of intraoperative complications, procedural volume (high volume centers: >20 cases, low volume < 20 cases) and to the learning curve (first 50% cases vs. second 50% cases of each center).
Results: Mean age was 81±7 years (Range: 44-95), 59.1% were female, mean logistic EUROscore was 26±14%. Preoperative peak (PG) and mean (MG) transaortic gradients were 82±24 and 51±16 mmHg, respectively. Mean follow-up was 10±8 months (range: 1-32). Hospital mortality was 7.7% (44 patients). Intraoperative severe complications occurred in 41 patients (7.2%). Overall 2-year survival was 69.6±4.6% (Fig. 1). At discharge PG and MG were 18±7 and 10±4 mmHg, respectively. These values remained stable 1 and 12 months after surgery. Independent risk factors for mortality after TA-TAVI were: NYHA class III and IV; logistic EUROscore >20; creatinine >200 mmol/L and intraoperative complications. Patients who experienced intraoperative complications had a significant worse 20 months survival (26±12% vs. 73±5%; p<0.001). Survival of the first 50% patients of each center and survival of patients operated on in high vs. low volume centers was not significantly different.
Conclusions: According to these data from our national Registry TA-TAVI appears to be a safe and effective alternative treatment for patients who are inoperable or too high risk for surgery. Intraoperative severe complications significantly affects survival while procedural volume and the initial experience seem to have no impact on patients survival.
- © 2011 by American Heart Association, Inc.