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Many patients with severe aortic stenosis (AS) and coexisting conditions are not candidates for surgical aortic valve replacement (SAVR). For these patients, transcatheter aortic valve implantation (TAVI) has emerged as a new therapeutic option. We sought to discover whether TAVI really can overcome the limitation of patient selection for SAVR in severe symptomatic AS patients.
We divided 126 consecutive patients with symptomatic high–grade AS that underwent TAVI with the Edward SAPIEN prosthesis into two groups based on operability.
The overall patient population was old (84.8±8.0 years), with a high prevalence of percutaneous coronary intervention and/or coronary artery bypass graft history (62.7%). They were at high surgical risk (STS score, 11.4±3.5%, logistic EuroSCORE (LES), 28.4±17.0%). There were 20 (15.9%) inoperable patients among total 126 patients. They were younger (78.9±12.8 vs. 85.9±6.2, p=.033) and had higher pulmonary arterial pressure (52.0±14.0 vs. 44.0±16.3 mmHg, p=.032) than operable patients. There were no difference of surgical risks (STS score, 11.3±6.7 vs. 11.4±2.6, p=.413; LES, 28.9±16.6 vs. 28.3±17.1, p=.706) between the two groups. The follow–up duration was 11 months (IQR 6 to 12). In the first 30 days after the procedure, 8/126 (6.4%) patients died. The all–cause death rates were 19.8% and 23.8% at 6 and 12–month respectively. There were no statistical difference of all–cause death rates between inoperable and operable group at 6 (35.0% vs. 17.0%, p=.074) and 12 month (35.0% vs. 21.7%, p=.252) follow–up. The rates of rehospitalization from any cause (55.0% vs. 40.4%, p=.229) were also not significantly different between the two groups. High surgical risk was the independent predictor of mortality after procedure in the multivariate analysis.
We have shown that in patients with severe symptomatic AS who were at high surgical risk, the difference in mortality or morbidity after TAVI at 6 and 12 month was insignificant between two groups. Our findings indicate that for selecting patients, the inoperable condition may not be a limitation for TAVI. And high surgical risk itself was helpful for predicting mortality after TAVI.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 41. TCT@ACC–i2: Carotid, Neurovascular, and Endovascular Intervention
Presentation Number: 2114–246
- 2013 American College of Cardiology Foundation