Background: Trans-catheter aortic valve implantation (TAVI) is an alternative option for high risk or inoperable patients requiring surgical aortic valve replacement. The aim of our study was to assess early and mid-term outcomes of all non-transfemoral TAVI: trans-apical, axillary and trans-aortic.
Methods: From 2009 to November 2013, 336 patients underwent TAVI in our medical center, of whom 270 (80%) underwent trans-femoral (TF) implantation and 66 other TAVI approaches: 50 trans-apical, 11 trans-axillary and 5 trans-aortic. Follow-up was 100% complete. Mean age was 81±7.2 years and 31 patients were male (47%),
Results: Logistic EuroScore I and II risk was 23%±16 and 7%±5, respectively. In-hospital mortality was 7(11%). Successful valve implantation occurred in 63 patients (95%): one intra-operative mortality, one valve embolization with conversion to AVR, and one with moderate-severe AR. Five patients (8%) required a second valve, and two (3%) needed cardiopulmonary-bypass support. Major adverse events included CVA 2(3%), re-open for bleeding in 2(3%), AKI stage 2/3 in 17(26%), prolonged ventilation (>48h) in 7(9%), respiratory failure and tracheostomy in 5 (8%) and permanent pacemaker in 4(6%). At discharge, peak and mean AV gradients were 19±12 mm Hg and 11±8 mm Hg, respectively. There was no or only a trace of aortic regurgitation (AR) in 37 patients (56%), mild AR in 28 (42%) and one moderate-severe AR. Mean follow-up was 14±13 months (range 1-42). There were 12 late mortalities during follow-up (20% of hospital survivors). At follow-up 23% patients were in FC III/IV compared with 62% pre-op. At late echo, there was no or only trace of AR in 63% of patients , mild in 37% and none in moderate or severe AR. One-, two- and 3-year survival was 75%, 60% and 42%, respectively.
Conclusions: TAVI provides good early results for inoperable or very high-risk patients. However long-term survival is low, reflecting the frailty and severity of the co-morbidities of these patients. Patient selection remains challenging, requiring careful attention and assessment.
