SHA24/057006

Survival outcome of 100 patients who underwent TAVI Ali Al Masood, Saeed Al Ahmari, Hussein Al Amri, Moheeb Al Abdullah, Mohammad Al Otaiby, Saad Al Kasab, Adil Tash, Ahmed AlWatedi

Background  The first TAVI was performed in April 2002.  The first core valve in 2004.  CE Mark: • CoreValve: May 2007 • Edwards SAPIEN: Dec 2007 • Edwards SAPIEN XT: 2010

Background ď ŽTAVI is an alternative treatment for high risk patients with severe aortic stenosis (AS). ď ŽThe procedural success and survival have improved over time.

TAVI  We report the survival data of 100 patients who received TAVI at Prince Sultan Cardiac Center, Riyadh.  PSCC Experience • First case : Apr 2009 Edwards • The first CoreValve : June 2010

Methods Patient’s clinical, imaging and procedural data were collected in a data base  follow up at 6 month and yearly afterward.  Average F/U 12.5±9.9 months (inter-quartile range 4.0-20.5 months)

Methods ď Ž The mortality-free survival for the whole cohort was estimated using KaplanMeier survival ď Ž The differences in survival between the groups defined by EuroScore operative risk, type of prosthesis, and procedure approach were tested using Log Rank test

Demographics Characteristics

Value

Age (years): Mean±SD

78.8±8.8

Range

54-100

Gender: Males

55%

Females

45%

EuroSCORE (Operative Risk): Mean±SD

24.1±17.7

Median

19

Demographics BMI Normal Overweight Obese Blood pressure (mmHg) Systolic Diastolic Heart rate Medical history: Hypertension Diabetes COPD Coronary artery disease Myocardial infarction CABG Stroke Carotid disease Atrial fibrillation Peripheral vascular disease Percutaneous coronary intervention Hemoglobin (g/dl) Anemia Platelets count (1000 per µl)

29.8±6.4 16 (23.5%) 23 (33.8%) 29 (42.6%) 135.9±25.1 67.0±11.5 73.9±13.3 49 (74.2%) 45 (68.2%) 18 (27.7%) 37 (55.2%) 16 (24.2%) 11 (16.2%) 8 (12.1%) 18 (26.9%) 13 (20.6%) 38 (61.3%) 23 (34.3%) 12.1±1.5 26 (42.6%) 261.0±70.2

Types of valve prosthesis

TAVI approach Edwards (N=60)

CoreValve (N=40)

Total Procedure success: Overall Complications: Blood transfusion CHB requiring pacemaker Vascular Pericardial effusion Acute renal failure Wound infection Sepsis Cerebrovascular accident Myocardial infarction Any complication Follow up (months): mean ÂąSD Median (inter-quartile range) Mortality: 30-day mortality One mortality Cause of death Cardiac Non-cardiac Survival 30-day survival One survival

(95.6%) (33.3%) (22.7%) (15.6%) (10.9%) (9.2%) (7.7%) (6.0%) (5.9%) (0.0%) (69.1%) 12.5Âą9.9 10.0 (4.0-20.5) (5.9%) (11.8%) (60.0%) (40.04%) (94.1%) (88.2%)

Mortality

Results  95 % procedural success  30 days mortality • 10 % for Edward’s • 5 % for Core valve

 1 year mortality • 21 % for Edward • 10 % for Core valve

Cumulative mortality by approach

Mortality according to access  30 days • trans-femoral approach 9 % • trans-apical approach 11 %.

 The one year • trans-femoral 15 % • trans-apical 30 %

Mortality according to EUROSCORE

Limitation  Retrospective nature of the study design  Single center experience  Potential referral bias  Inconsistent timing of echocardiography

Conclusion ď Ž Elderly patients with severe AS and at high risk for surgery can undergo TAVI with high success rate, and acceptable mortality rate. ď Ž The highest mortality rate at one year was in patients who underwent transapical TAVI.

Conclusion  30-day survival (94.1%)  survival during an average of 12.5 months (88.2%)  Major post-procedure complications • bleeding requiring blood transfusion (33.3%) • CHB requiring pacemaker implantation (22.7%) • vascular injury (15.6%)

Conclusion ď Ž Complications but not survival were generally differential by the type and approach of the implanted prostheses as well as the patients operative risks