Abstract 15363: Transcatheter Aortic Valve Implantation with the Edwards Valve Prosthesis in Patients with Contra-Indication to Surgery but Low (<20%) Logistic Euroscore: Results of the Rouen Registry
Background: Transcatheter aortic valve implantation (TAVI) is increasingly accepted as a therapeutic option in patients with severe aortic stenosis (AS). A predictive Logistic Euroscore (Log ES) > 20% currently defines the high-risk population. However, TAVI is performed in a number of pts with a Log ES < 20% due to comorbidities not included in the calculation of the Log ES but increasing the risk of AVR. The TAVI results in this sugroup of “lower risk” patients needed to be assessed.
Population and Methods: We retrospectively analysed 205 consecutive Edwards balloon expandable TAVI patients included between May 2006 and April 2011 in our center, and compared the clinical characeristics and results at 30 days and 1 year of two groups according to the Log.ES < 20% (Low risk: LR): n=81 (39.5%), or > 20% (High risk: HR): n=124 (60.5%). The transfemoral approach was used in 151 (73.6%). Consortium (VARC) classification of TAVI complications and endpoints were used.
Results: Mean Log ES was 12.2 ± 4.8% and 32.2 ±10.2% in the LR and HR groups respectively. Major thoracic deformity (8.3 %), mediastinal radiotherapy (20%) and porcelain aorta (15%) were the dominant inclusion factors in the LS group. Patients in the LR group were younger (81±8 vs 84±5 years, p = 0.003), more often female (65.4% vs 46.8%, p = 0.01), with previous stroke (6.2% vs 17.7%, p=0.02) or CABG (5% vs 33.1%, p<0.001). There was no significant difference in NYHA class, presence of chronic respiratory failure, hypertension, diabetes. Procedural success was 100% vs 95.2% (p=0.05) in the LR and HR group respectively. There was no significant difference in major vascular complications (6.2 vs 5.6%), major acute stroke (1.2 vs 1.6%), infective complications (13.6 vs 18.5%), permanent pace maker (4.9 vs 5.7%) but less AKI class ≥ 2 (0% vs 5.6%, p=0.006) or life-threatening bleeding (16.6% vs 28.8%, p=0.1) in the LR vs HR groups and a better safety end point (9.9% vs 27.4%, p=0.02) and survival at 30-day (100% vs 87.1%, p=0.01) and 1 year (88.9 vs 69.7 %, p<0.01) in the LR group.
Conclusions: In patients with contra-indication to surgery but low Log ES (< 20%), TAVI is associated with similarly good procedural success and better safety end point and mortality rates at 30-Day and 1 year than in the regular high risk population.
- © 2011 by American Heart Association, Inc.