Original Scientific Article
Journal of Structural Heart Disease, April 2018, Volume 4, Issue 2:33-41
Towards "Primary" TAVI: Transcatheter Aortic Valve Implantation without Computerised Tomography, Transoesophageal Echocardiography or General Anaesthesia
Does Retrospective Data Provide Support for the Concept?
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
Background: In the elective setting, advanced adjunctive technology is appropriately used to aid TAVI. However, 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 tomography (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. Aortic 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%), local 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%). Aortic regurgitation ≥grade2 (moderate/severe) was observed in 12.5%. Mortality rates were 9.3%, (30-day) and 15.2% (one-year).
Conclusion: A minimalist approach to TAVI does not offer contemporary levels of procedural success. A 95% success rate may be considered acceptable in emergency or urgent settings. A self-expanding prosthesis may be particularly suited to this clinical scenario.
Cite this article as: Cockburn J, Spence M, Owens C, Manoharan G, Trivedi U, de Belder A, Laborde J, Hildick-Smith D. Towards "Primary" TAVI: Transcatheter Aortic Valve Implantation without Computerised Tomography, Transoesophageal Echocardiography or General Anaesthesia – Does Retrospective Data Provide Support for the Concept?. Structural Heart Disease 2018;4(2):33-41. DOI: 10.12945/j.jshd.2018.046.17
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