Background: Transcatheter aortic valve implantation (TAVI) is the treatment of choice for high risk\no option patients with severe aortic stenosis (AS).
Methods: Patients with severe AS (N=262) were treated and followed prospectively: 162 femoral Corevalve; 18 axillary Corevalve; 1 aortic Corevalve; 1 retroperitoneal Corevalve; 52 femoral Sapien and 28 apical Sapien. Patients (60% women) were characterized by advanced age (mean 81.7±6.8), high prevalence of severe comorbidities: 32% diabetes mellitus, chronic kidney disease 83%, COPD 24%. Mean logistic EuroScore 19.1±12 and STS 8.1±5. Mean follow up were 650±423. Herein we describe our short and long-term experiences with TAVI defined by the Valve Academic Research Consortium 2 (VARC 2) definitions.
Results: Procedural success was 97.2%. However, according to the VARC 2 definitions, device success was achieved in only 92.1 % of cases since there was a need for a second valve implant in 13(5%) patients. One month, 1 year, 2 and 3 years survival rates were 97%, 91%, 85% and 70%; respectively. There were 2(0.7%) patients who needed urgent cardiac surgery due to tamponade. Vascular complications occurred in 51(19.6%) cases mostly treated using catheter-based approach. Peri-procedural\in-hospital stroke was diagnosed in 9(3.4%) patients. Permanent pacemaker was required in 39(15%) patients: 20% in Corevalve and 3.7% in Sapien valves. Paravalvular leak (≥moderate) was noted in 22(8.4%) patients. The median length of hospital stay was 5±4.5 days. After the procedure, mean valve gradients decreased from 49.2±17 to 8.3±8 (p<0.001). Symptomatic improvement was evident during follow up, having 98% of patients in NYHA-FC I/II.
Conclusions: The treatment of sick elderly patients with severe AS using TAVI is feasible, effective and relatively safe. Remaining issues to resolve are: ≥moderate paravalvular leaks, stroke events, vascular complications and valve malposition having an impact upon procedural success vs. device success rates as defined by the VARC 2 procedural criteria.
