scholarly journals Indications and outcomes of TAVI (transcatheter aortic valve implantation) in Iceland

2021 ◽  
Vol 107 (03) ◽  
pp. 123-129
Author(s):  
Katrín Júníana Lárusdóttir ◽  
◽  
Hjalti Guðmundsson ◽  
Árni Johnsen ◽  
Martin Ingi Sigurðsson ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Reference Population ◽  
Aortic Valve Area ◽  
Term Survival ◽  
Long Term Survival ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

INTRODUCTION: Surgical aortic valve replacement (SAVR) has been the standard of treatment for aortic stenosis but transcatheter aortic valve implantation (TAVI) is increasingly used as treatment in Iceland and elsewhere. Our objective was to assess the outcome of TAVI in Iceland, focusing on indications, complications and survival. MATERIAL AND METHODS: This retrospective study included all TAVI-procedures performed in Iceland between January 2012 and July 2020. Patient characteristics, outcome and complications were registered, and overall survival compared to an age and sex matched Icelandic reference-population. The mean follow-up was 2.4 years. RESULTS: Altogether 189 TAVI procedures (mean age 83±6 years, 41.8% females), were performed, all with a self-expandable valve. Most patients (81.5%) had symptoms of severe heart failure (NYHA-class III-IV) and median EuroSCORE-II was 4.9 (range: 0.9-32). Echocardiography pre-TAVI showed a mean aortic-valve area of 0.67 cm2 and max aortic-valve gradient of 78 mmHg. One out of four patients (26.5%) needed permanent pacemaker implantation following TAVI. Other complications were mostly vascular-related (13.8%) but cardiac tamponade stroke was detected in 3.2 and 2.6% of cases, respectively and severe paravalvular aortic valve regurgitation in 0.5% cases. Thirty-day mortality was 1.6% (n=3) with one-year survival of 93.5% (95% CI: 89.8-97.3), but long-term survival of TAVI-patients was similar to the matched reference population (p=0.23). CONCLUSIONS: The outcome of TAVI-procedures in Iceland is good, especially regarding 30-day mortality and long-term survival that was comparable to a reference population, but incidence of major complications was also low.

scholarly journals Apical vs subclavian transcatheter aortic valve implantation: an 8-year United Kingdom analysis

2021 ◽  
Author(s):  
Francesca D'Auria ◽  
Danilo Flavio Santo ◽  
Aung Myat ◽  
Roberto Lorusso ◽  
Justine Ravaux ◽  
...  
Keyword(s):  
United Kingdom ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Secondary Outcome ◽  
Term Survival ◽  
Long Term Survival ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objectives: Subclavian (SC) and transapical (TA) approach are the main alternatives to the default femoral delivery for transcatheter aortic valve implantation (TAVI). Aim of this study was to compare, complications and morbidity/mortality associated with SC and TA in a long-term time frame. Methods: From January 2007 to July 2015, 1,506 patients underwent TAVI surgery in 36 United Kingdom TAVI centres. Primary outcomes were complications according to VARC-2 criteria. The secondary outcome was long-term survival. Results: The enrolled patients were distributed as follows: 1,216 in the trans-apical (TA) group and 290 in the subclavian (SC) group. There were no differences in the rates of acute myocardial infarction, emergency valve-in-valve, paravalvular leak, balloon post dilatation, cardiac tamponade, stroke, renal replacement therapy, vascular injuries, and 30-days mortality among the groups. Conversely, the rate of permanent pacemaker implantation (p = 0.02), the procedural time duration (p = 0.04), and the 12-month mortality (p = 0.03) was higher in SC than in TA, while in-hospital length of stay was reduced in SC than in TA (p = 0.01). Up to 8-years, the long-term mortality was not different among groups (p = 0.77), and no difference in long-term survival between self vs balloon expandable device was found (p = 0.26). Conclusions: According to our results, TA provided the best 12-months survival compared to SC, while the long-term survival up to 2, 900 days is not significantly different between groups, so SC and TA may both represent a safe non-femoral access if femoral is precluded.

P1792Delirium after transcatheter aortic valve implantation (TAVI) under general anaesthesia: incidence, predictors and relation to long-term survival

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Van Der Wulp ◽  
M H Van Wely ◽  
L Van Heijningen ◽  
B M A Van Bakel ◽  
Y Schoon ◽  
...  
Keyword(s):  
Aortic Valve ◽  
General Anaesthesia ◽  
Transcatheter Aortic Valve Implantation ◽  
Term Survival ◽  
Long Term Survival ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
Long Term Mortality

Abstract Background Patients undergoing Transcatheter Aortic Valve Implantation (TAVI) are at risk of postoperative delirium (POD). Prospectively collected data on delirium after TAVI are scarce. Purpose Aim of this study is to report the incidence and risk factors of POD after TAVI under general anaesthesia. Also we assessed the relation of POD with clinical outcome and short- and long-term survival. Methods POD was assessed prospectively in all consecutive patients treated with TAVI in our centre between 2008 and 2017, according to the Diagnostic and Statistical Manual of Mental Disorder (DSM)-IV criteria. TAVI was performed under general anaesthesia in all patients. Outcome was reported according to the updated VARC2-criteria. Survival status was checked by consulting the Municipal Civil Registries. Results POD was observed in 16.5% (116/703) of all patients. Stroke and new onset of atrial fibrillation were more often observed in patients with POD (6.9% vs. 1.9%, p=0.007 and 12.1% vs. 5.1%, p=0.005, respectively). Independent preoperative predictors of POD were prior delirium (OR 2.56 [95% CI: 1.52–4.31], p<0.001), aortic valve area (AVA)<0.75 cm2 (OR 2.39 [1.53–3.74], p<0.001), age (1.08 [1.04–1.12], p<0.001) and BMI (0.94 [0.90–0.99], p=0.018). POD was the strongest independent predictor of long-term mortality (HR 1.91 [1.36–2.70], p<0.001) and was associated with impaired 30-day survival (92.2% vs. 96.8%, p=0.034) as well as 5-year survival (40.0% vs. 50.0%, p<0.001). Survival: Delirium vs No Delirium Conclusion One-in-six patients suffered from POD after TAVI under general anaesthesia. Prior delirium and more calcified aortic valve were the strongest independent predictors of POD. POD was the strongest predictor of long-term mortality and was associated with impaired short- as well as long-term survival.

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