Page 14 - Journal of Structural Heart Disease Volume 4, Issue 2

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Original Scienti c Article
tional hazards models. A Kaplan-Meier survival curve was drawn to assess di erences between groups for time-to-event data. Analyses were performed using Stata 10.1 (StataCorp, College Station, TX, USA).
Results
Patient Demographics and Pre-Procedural Characteristics
Baseline demographics including risk factors are shown in Table 1. Patients were aged 81.4 ± 7.0 years, and 46.3% were male. Mean logistic EuroSCORE was 19.2 ± 11.0. Approximately one-quarter of patients (28.8%) had signi cant coronary artery disease in- volving at least one epicardial coronary artery, 15.8% had extensive aortic calci cation, and mean creati- nine was 127.7 ± 80 mmol-1.
TAVI was indicated for signi cant aortic stenosis in 90.3% of cases, aortic regurgitation in 4.7%, and mixed aortic valve disease in 5.0%. “Valve-in-valve” due to previous surgical bio-prosthesis failure repre- sented 5.7% of cases, and 1.8% of cases were for true bicuspid valve stenosis (Table 2).
Pre-procedural assessment of the aortic valve complex, including annular measurement, was made by TTE (73.4%), TEE (24.5%), or MSCT (0.5%). Mean annular diameter in the overall patient cohort was 23.1 ± 2.4 mm. Mean peak aortic gradient was 79.7 ± 25.2 mmHg, and mean valve area was 0.62 ± 0.20 cm2 (Table 2). Analysis of vessel diameter, tortuosity, and calci cation was made by iliofemoral angiography (99.5%) or MSCT (0.5%; Table 2).
With regard to procedural anesthesia, GA was used in 14.9% of cases, usually for “surgical” approaches to TAVI. Most procedures were performed under local anesthesia (lignocaine 1%) with either intravenous paracetamol (39.1%) or conscious sedation (remifen- tanil/propofol; 46%).
Peri-Procedural Characteristics
Peri-procedural characteristics are shown in Table 2. Most patients (87.7%) underwent TAVI using the self-expanding CoreValve prosthesis (Medtronic CoreValve System, Medtronic, Luxembourg). Proce- dures were performed via the retrograde transfem- oral (90.7%), subclavian (4.9%), axillary (0.5%), direct aortic (2.3%), or trans-apical approach (1.3%). Other
Table 1. Patient demographics
Age yr (mean±SD)
Male sex (%) no./total no. Height cm (mean±SD)
Weight kg (mean±SD) Caucasian
Logistic EuroSCORE (mean±SD) NYHA class (%) no./total no.
81.4 ±7.0 (384) 46.3 (177/382) 165±9.3 74.1±15.2 (382) 99.4 (382/384)
9.9 (38/383) 66.3 (254/383) 22.5 (86/383)
2.4 (9/381) 13.1 (50/382) 7.3 (28/382) 6.0 (23/382) 15.8 (60/380)
23.8 (91/383)
21.7 (83/382) 6.5 (25/382) 1.8 (7/382)
24.0 (92/383) 10.2 (39/384) 21.4 (82/383)
19.3 (74/383) 3.7 (14/383)
4.7 (18/384) 8.9 (34/384) 3.9 (15/384) 25.5 (97/380)
6.0 (23/383)
3.4 (13/383) 18.8 (72/383) 127.7±80.0 (378)
Characteristic
TAVI N=384
II IV Coronary artery disease (%) no./total no. Left main stem 1 vessel with diameter stenosis >50% 2 vessel with diameter stenosis >50% 3 vessel with diameter stenosis >50%
Extensive calci cation of the acending aorta (%) no./total no.
Previous myocardial infarction (%) no./total no.
Previous intervention (%) no./total no.
Coronary artery bypass surgery Surgical valve replacement
Other operation requring opening of the pericardium Percutaneous coronary intervention
Balloon aortic valvuloplasty Diabetes disease (%) no./total no.
Pulmonary disease (%) no./total no.
Asthma Chronic obstructive pulmonary disease
Neurological disease (%) no./total no.
Transient ischaemic attack Cerebrovascular accident Other neurological condition Peripheral vascular disease (%) no./total no.
Permenant pacemaker (%) no./total no.
Pre TAVI prophylaxis Previous PPM insertion
Atrial brillation (%) no./total no. Creatinine (mean±SD)
II
NYHA = New York Heart Association; TAVI = Transcatheter aortic valve im- plantation; PPM = Permanent pacemaker
Cockburn J. et al.
Towards Primary TAVI