TAVI in High-Risk Patients: One-center Results Study

Renat Akchurin, Timur Imaev, Petr Lepilin, Alexey Komlev, Alexandr Kolegaev, Dmitriy Salichkin, Ivan Kuchin, Anna Margolina, Maxim Makeev, Sergey Ternovoy

National medical research center for cardiology, Moscow, Russia

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has been used worldwide in high-risk patients with severe aortic stenosis.

Objectives: The aim of this study was to analyze the short and long-term post-operative outcomes in this group of patients.

Method: We performed a retrospective analysis on all patients who underwent TAVI procedure with use of different technical approaches. This was a single surgical brigade and single center study. Study endpoints included early and late mortality and cardiovascular events.

Results: 517 patients with a median age of 72,4±4.8 (66-92) years were included. An average mean pressure gradient was 47± 6.6mmHg. In 414 cases implantation was performed through transfemoral access (including 287 Edwards Sapien, 219 - CoreValve) and in 75 cases - transapical access was used due to vascular abnormalities. In the rest 18 patients we used direct access - transaortic (8 cases) and in 10 cases - transsubclavian approach.

Intraoperative mortality was 1.25%.Total 30 days mortality rate was 4.25%, non-fatal stroke rate accounts for 2.5%. In 2,5% patients at the first 50 TAVI cases group the procedure of hemodialysis needed to be performed because of acute contrast-induced renal injury. There were no difference between groups as regards to major bleeding (0,2%) and other vascular complications. Permanent pacemaker implantation was required in 8.75%. The average mean pressure gradient after Edwards Sapien and Medtronic CoreValve implantations were 10,9±3,5 and14,3±5,4 mm Hg respectively.The overall mortality rate by the end of 1-year follow-up was 13% with no procedure-related deaths.

Conclusion: There are no significant difference between procedural success and complication rate with use of different approaches despite of certain technical issues of Tao-TAVI application. TAVI is referred to as a present-day strategy for treatment of severe AS in high-risk patients. One experience corresponds well to studies in terms of feasibility and safety.