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