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Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation

Wenaweser, Peter ; Stortecky, Stefan ; Schwander, Sarah ; Heg, Dik ; Huber, Christoph ; Pilgrim, Thomas ; Gloekler, Steffen ; O'Sullivan, Crochan J. ; Meier, Bernhard ; Jüni, Peter ; Carrel, Thierry ; Windecker, Stephan

In: European Heart Journal, 2013, vol. 34, no. 25, p. 1894-1905

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    Titre
    • Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation
    Auteur
    • Wenaweser, Peter. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Stortecky, Stefan. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Schwander, Sarah. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Heg, Dik. Department of Clinical Research, Clinical Trials Unit, Bern, Switzerland
    • Huber, Christoph. Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Pilgrim, Thomas. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Gloekler, Steffen. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • O'Sullivan, Crochan J.. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Meier, Bernhard. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    • Jüni, Peter. Department of Clinical Research, Clinical Trials Unit, Bern, Switzerland
    • Carrel, Thierry. Department of Cardiovascular Surgery, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
    • Windecker, Stephan. Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, 3010 Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Heart Journal, 2013, vol. 34, no. 25, p. 1894-1905. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:294927
    Summary
    Aims Transcatheter aortic valve implantation (TAVI) is an established treatment alternative to surgical aortic valve replacement in high-risk and inoperable patients and outcomes among patients with estimated low or intermediate risk remain to be determined. The aim of this study was to assess clinical outcomes among patients with estimated low or intermediate surgical risk undergoing TAVI. Methods and results Between August 2007 and October 2011, 389 consecutive patients underwent TAVI and were categorized according to the Society of Thoracic Surgeons (STS) score into low (STS < 3%; n = 41, 10.5%), intermediate (STS ≥3% and ≤8%, n = 254, 65.3%), and high-risk (STS > 8%; n = 94, 24.2%) groups for the purpose of this study. Significant differences were found between the groups (low risk vs. intermediate risk vs. high risk) for age (78.2 ± 6.7 vs. 82.7 ± 5.7 vs. 83.7 ± 4.9, P < 0.001), body mass index (28.1 ± 6.1 vs. 26.5 ± 4.9 vs. 24.4 ± 4.6, P < 0.001), chronic renal failure (34 vs. 67 vs. 90%, P < 0.001), all-cause mortality at 30 days (2.4 vs. 3.9 vs. 14.9%, P = 0.001), and all-cause mortality at 1 year (10.1 vs. 16.1 vs. 34.5%, P = 0.0003). No differences were observed with regards to cerebrovascular accidents and myocardial infarction during 1-year follow-up. Conclusion In contemporary practice, TAVI is not limited to inoperable or STS-defined high-risk patients and should be guided by the decision of an interdisciplinary Heart Team. Compared with patients at calculated high risk, well-selected patients with STS-defined intermediate or low risk appear to have favourable clinical outcomes