Page 12 - Journal of Structural Heart Disease Volume 4, Issue 2

Original Scienti c Article
Journal of Structural Heart Disease, April 2018, Volume 4, Issue 2:33-41
DOI: https://doi.org/10.12945/j.jshd.2018.046.17
Received: November 23, 2017 Accepted: December 19, 2017 Published online: April 2018
Towards "Primary" TAVI: Transcatheter Aortic Valve Implantation without Computerised Tomography, Transoesophageal Echocardiography or General Anaesthesia Does Retrospective Data Provide Support for the Concept?
James Cockburn, MD1*, Mark S. Spence, MD2, Colum Owens, MD2, Ganesh Manoharan, MD2, Uday Trivedi, MD1, Adam de Belder, MD1, Jean-Claude Laborde, MD3, David Hildick-Smith, MD1
1 Department of Cardiology, Sussex Cardiac Centre, Brighton and Sussex University Hospitals, UK, Brighton, United Kingdom 2 Department of Cardiology, Royal Victoria Hospital, Belfast Trust, Belfast, United Kingdom
3 Department of Cardiology, St. Georges Hospital, Tooting, London, United Kingdom
Abstract
Background: In the elective setting, advanced adjunc- tive technology is appropriately used to aid TAVI. How- ever, extensive pre-procedural work-up may not be possible in an acute setting.
Methods: We examined retrospective data from early TAVI practice to inform the concept of "primary" acute TAVI. Data was examined from two UK TAVI centres (2007-2012) prior to routine use of computerised to- mography (CT). 30-day and 1 year clinical outcomes were assessed. Mortality tracking was obtained as of December 2012.
Results: 384 underwent TAVI at the two sites during this period. Patients were aged 81.4±7.0 years. 46.3% were male. Logistic EuroSCORE was 19.2±11.6. Peak aortic valve gradient and aortic valve area were 79.7±25.2mmHg and 0.62±0.20cm2 respectively. Aor- tic annular size was assessed by transthoracic echo (TTE; 73.4%) or transoesophageal echo (TOE; 24.5%) and was 23.1±2.4mm. Iliofemoral assessment was by invasive contrast angiography (99.5%). Procedures were performed under local anaesthetic (39.1%), lo- cal anaesthetic and anaesthetic sedation (46.0%), or general anaesthesia (14.9%). Device implantation was predominantly with the CoreValve self-expanding
prosthesis (87.7%), via the femoral approach (90.7%). Procedural imaging was TTE (85%), TOE (3.4%), or none (11.6%). Device implantation success rate was 96.1%. Procedural complications included death (0.8%) and emergency valve-in-valve implantation (3.1%). Aor- tic regurgitation ≥grade2 (moderate/severe) was ob- served in 12.5%. Mortality rates were 9.3%, (30-day) and 15.2% (one-year).
Conclusion: A minimalist approach to TAVI does not of- fer contemporary levels of procedural success. A 95% success rate may be considered acceptable in emergen- cy or urgent settings. A self-expanding prosthesis may be particularly suited to this clinical scenario.
Copyright © 2018 Science International Corp.
Key Words
Primary TAVI • Minimalist approach
Introduction
Aortic stenosis a ects 5% of people over the age of 75 years [1]. Left untreated, prognosis is poor. Trans-catheter aortic valve implantation (TAVI) has become an established treatment for patients with
* Corresponding Author:
James Cockburn, MD
Sussex Cardiac Centre
Brighton and Sussex University Hospitals, UK
Eastern Road, Brighton, BN2 5BE, United Kingdom
Tel. + 44 1273 696955; Fax: +441273 696956; E-Mail: james.cockburn@bsuh.nhs.uk
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
© 2018 Journal of Structural Heart Disease Published by Science International Corp. ISSN 2326-4004
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