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OUTCOME OF PATIENTS WITH SEVERE SYMPTOMATIC AORTIC STENOSIS SCREENED FOR TRANSCATHETER AORTIC VALVE IMPLANTATION AND TREATED WITH SURGICAL AORTIC VALVE REPLACEMENT
E1372 JACC April 5, 2011 Volume 57, Issue 14
VALVULAR HEART DISEASE OUTCOME OF PATIENTS WITH SEVERE SYMPTOMATIC AORTIC STENOSIS SCREENED FOR TRANSCATHETER AORTIC VALVE IMPLANTATION AND TREATED WITH SURGICAL AORTIC VALVE REPLACEMENT ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Valvular Disease- TAVI in the 21st Century- Understanding the Process Abstract Category: 19. Valvular Disease Session-Poster Board Number: 1116-56 Authors: Itsik Ben-Dor, Michael A. Gaglia, Jr., Gabriel Maluenda, Michael Mahmoudi, Gabriel Sardi, Kohei Wakabayashi, Manuel A. Gonzalez, Rafael Romaguera, Ana Laynez-Carnicero, Rebecca Torguson, Petros Okubagzi, William O. Suddath, Joseph Lindsay, Lowell F. Satler, Augusto D. Pichard, Ron Waksman, Washington Hospital Center, Washington, DC Background: In patients with severe aortic stenosis (AS) who are considered poor candidates for surgical aortic valve replacement (sAVR), transcatheter aortic valve implantation (TAVI) has demonstrated superiority over medical therapy / balloon valvuloplasty (BAV) in reduction of 1-year mortality. Currently TAVI is being evaluated against sAVR in patients with severe AS who are considered high-risk surgical candidates. This study aimed to detect the 1-year mortality rate of patients with severe AS who were screened for TAVI but treated with sAVR. Methods: From April 2007 to September 2010 a cohort of 134 patients with severe AS who were screen failures for the TAVI versus sAVR study were detected and referred for sAVR. Clinical follow-up of these patients was obtained by telephone contact or office visit. Results: The leading causes for screen failure to participate in the study were low Society of Thoracic Surgeons (STS) score <10%: 64 (47.7%), significant coronary artery disease: 20 (14.9%), aortic valve area >0.8 cm2: 8 (5.9%). The cohort mean age was 79.1±8.2, the STS score was 8.4±4.7, and the logistic EuroSCORE was 25.7±17.9. This cohort had many comorbidities with diabetes 45 (33.5%), coronary artery disease 80 (59.7%), cerebrovascular event 13 (9.7%), and renal failure 40 (29.8). The mean aortic valve area was 0.74±0.18cm2, mean gradient was 43.8±17.05 mmHg, and the mean ejection fraction was 54.9±14.7. During median follow up of 445[170-779] days the mortality rate was 26.9% (n=36). Conclusion: The 1-year all-cause mortality rates recorded in patients with severe AS who are undergoing sAVR and who are at a lesser risk when compared with patients enrolled into the TAVI US trials are high. TAVI procedures should be considered as an alternative to sAVR in patients with slightly less risk to those who are being enrolled in US TAVI trials.
VALVULAR HEART DISEASE OUTCOME OF PATIENTS WITH SEVERE SYMPTOMATIC AORTIC STENOSIS SCREENED FOR TRANSCATHETER AORTIC VALVE IMPLANTATION AND TREATED WITH SURGICAL AORTIC VALVE REPLACEMENT ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.
Session Title: Valvular Disease- TAVI in the 21st Century- Understanding the Process Abstract Category: 19. Valvular Disease Session-Poster Board Number: 1116-56 Authors: Itsik Ben-Dor, Michael A. Gaglia, Jr., Gabriel Maluenda, Michael Mahmoudi, Gabriel Sardi, Kohei Wakabayashi, Manuel A. Gonzalez, Rafael Romaguera, Ana Laynez-Carnicero, Rebecca Torguson, Petros Okubagzi, William O. Suddath, Joseph Lindsay, Lowell F. Satler, Augusto D. Pichard, Ron Waksman, Washington Hospital Center, Washington, DC Background: In patients with severe aortic stenosis (AS) who are considered poor candidates for surgical aortic valve replacement (sAVR), transcatheter aortic valve implantation (TAVI) has demonstrated superiority over medical therapy / balloon valvuloplasty (BAV) in reduction of 1-year mortality. Currently TAVI is being evaluated against sAVR in patients with severe AS who are considered high-risk surgical candidates. This study aimed to detect the 1-year mortality rate of patients with severe AS who were screened for TAVI but treated with sAVR. Methods: From April 2007 to September 2010 a cohort of 134 patients with severe AS who were screen failures for the TAVI versus sAVR study were detected and referred for sAVR. Clinical follow-up of these patients was obtained by telephone contact or office visit. Results: The leading causes for screen failure to participate in the study were low Society of Thoracic Surgeons (STS) score <10%: 64 (47.7%), significant coronary artery disease: 20 (14.9%), aortic valve area >0.8 cm2: 8 (5.9%). The cohort mean age was 79.1±8.2, the STS score was 8.4±4.7, and the logistic EuroSCORE was 25.7±17.9. This cohort had many comorbidities with diabetes 45 (33.5%), coronary artery disease 80 (59.7%), cerebrovascular event 13 (9.7%), and renal failure 40 (29.8). The mean aortic valve area was 0.74±0.18cm2, mean gradient was 43.8±17.05 mmHg, and the mean ejection fraction was 54.9±14.7. During median follow up of 445[170-779] days the mortality rate was 26.9% (n=36). Conclusion: The 1-year all-cause mortality rates recorded in patients with severe AS who are undergoing sAVR and who are at a lesser risk when compared with patients enrolled into the TAVI US trials are high. TAVI procedures should be considered as an alternative to sAVR in patients with slightly less risk to those who are being enrolled in US TAVI trials.