Page 15 - Journal of Structural Heart Disease Volume 4, Issue 2

Original Scienti c Article
36
Table 2. Pre-procedural characteristics.
Heart team meeting (%) no./total no. Primary reason for TAVI (%) no./total no.
High risk for surgical AVR Formally turned down for surgical AVR Patient refused surgical AVR
Aortic valve aetiology (%) no./total no. Degenerative
Rheumatic Failed bioprosthesis Bicuspid
Aortic valve pathology (%) no./total no. Stenosis
Regurgitation Mixed
Pre-procedural assessment of the aortic valve complex
Aortic annular measurement method (%) no./total no.
TTE TOE Contrast aortography CT with valve perimetry
Aortic valve measurements (mean±SD) Aortic valve area - cm2 Peak aortic valve gradient - mmHg Aortic annular diameter - mm
Left ventricular function (%) no./total no. Good 50-60
Moderate 30-50 Poor <30
Pulmonary hypertension (%) no./total no. PA systolic >60mmHg
Pre-procedural assessment of the illiofemoral vessels
Contrast illiofemoral angiography CT
Anaesthesia
Local anaesthetic and IV paracetmaol Local anaesthetic and conscious sedation
General anaesthesia
100 (384/384)
65.0 (249/383) 30.6 (117/383) 4.4 (17/383)
89.8 (344/383) 2.3 (9/383) 5.7 (22/383) 1.8 (7/383)
90.3 (346/383) 4.7 (18/383) 5.0 (19/383)
73.4 (281/383) 24.5 (94.383) 1.6 (6/383) 0.5 (2/383)
0.62±0.2 (380) 79.7±25.17 (382) 23.1±2.4 (381)
79.8 (305/382) 14.9 (57/382) 5.2 (20/382)
13.0 (50/384)
99.5 (383/381) 0.5 (2/383)
39.1 (150/383) 46.0 (176/383) 14.9 (57/383)
Figure 1. Kaplan-Meier survival curve for all patients to 1 year.
valve systems used were the Edwards Sapien (Ed- wards Life Science, Irvine, CA, USA) in 7.3% of cases and the Portico valve (St. Jude Medical, Minneapolis, MN, USA) in 5.0% of cases. Most (86%) patients un- derwent percutaneous pre-closure using the Prostar vascular closure system (Perclose Inc., Menlo Park, CA, USA).
Implantation was performed under contrast aor- tography (100%) with or without additional TTE (85%). Peri-procedural TEE was utilized in 3.4% of cas- es. Post-procedure para-valvular aortic regurgitation was assessed using hemodynamics, TTE, and contrast aortography.
Device Success and Complications
Device implantation success was achieved in 96.1% of cases (Table 4). Three patients (0.8%) died intra-procedure. Twelve patients (3.1%) required emergency second valve implantation at the time of the index procedure for on-table severe paraval- vular aortic regurgitation (PAR). No patient required conversion to emergency open valve surgery. Five patients (1.3%) required subsequent “valve-in-valve” implantation as a separate procedure.
In-hospital complications are detailed in Table 4. In-hospital MACE rate was 6.0%. The incidences of stroke and myocardial infarction were 2.0% and 0.3%, respectively. Post-procedural aortic regurgitation grade by uoroscopic aortography was 0 (37.3%), 1 (45.6%), 2 (12%), or >2 (0.8%). Post-procedure aortic regurgitation grade by TTE was zero (36.2%), mild (52.2%), moderate (10%), or severe (0.5%). VARC-de-
Pre-procedural characteristics
TAVI N=384
AVR = aortic valve replacement; TTE = transthoracic echocardiogram; TOE = transoesophageal echocardiogram
Journal of Structural Heart Disease, April 2018
Volume 4, Issue 2:33-41