Clinical outcome and predictors for adverse events after transcatheter aortic valve implantation with the use of different devices and access routes

Wenaweser, Peter; Pilgrim, Thomas; Roth, Nadja; Kadner, Alexander; Stortecky, Stefan; Kalesan, Bindu; Meuli, Fabienne; Büllesfeld, Lutz; Khattab, Ahmed A; Huber, Christoph; Eberle, Balthasar; Erdös, Gabor; Meier, Bernhard; Jüni, Peter; Carrel, Thierry; Windecker, Stephan (2011). Clinical outcome and predictors for adverse events after transcatheter aortic valve implantation with the use of different devices and access routes. American Heart Journal, 161(6), pp. 1114-1124. St. Louis, Mo.: Elsevier 10.1016/j.ahj.2011.01.025

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Background

Transcatheter aortic valve implantation (TAVI) is a treatment option for high-risk patients with severe aortic stenosis. Previous reports focused on a single device or access site, whereas little is known of the combined use of different devices and access sites as selected by the heart team. The purpose of this study is to investigate clinical outcomes of TAVI using different devices and access sites.

Methods

A consecutive cohort of 200 patients underwent TAVI with the Medtronic CoreValve Revalving system (Medtronic Core Valve LLC, Irvine, CA; n = 130) or the Edwards SAPIEN valve (Edwards Lifesciences LLC, Irvine, CA; n = 70) implanted by either the transfemoral or transapical access route.

Results

Device success and procedure success were 99% and 95%, respectively, without differences between devices and access site. All-cause mortality was 7.5% at 30 days, with no differences between valve types or access sites. Using multivariable analysis, low body mass index (<20 kg/m2) (odds ratio [OR] 6.6, 95% CI 1.5-29.5) and previous stroke (OR 4.4, 95% CI 1.2-16.8) were independent risk factors for short-term mortality. The VARC-defined combined safety end point occurred in 18% of patients and was driven by major access site complications (8.0%), life-threatening bleeding (8.5%) or severe renal failure (4.5%). Transapical access emerged as independent predictor of adverse outcome for the Valve Academic Research Consortium–combined safety end point (OR 3.3, 95% CI 1.5-7.1).

Conclusion

A heart team–based selection of devices and access site among patients undergoing TAVI resulted in high device and procedural success. Low body mass index and history of previous stroke were independent predictors of mortality. Transapical access emerged as a risk factor for the Valve Academic Research Consortium–combined safety end point.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Wenaweser, Peter Martin, Pilgrim, Thomas, Kadner, Alexander, Stortecky, Stefan, Kalesan, Bindu, Büllesfeld, Lutz, Khattab, Ahmed Aziz, Huber, Christoph, Eberle, Balthasar, Erdoes, Gabor (A), Meier, Bernhard, Jüni, Peter, Carrel, Thierry, Windecker, Stephan

ISSN:

0002-8703

Publisher:

Elsevier

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

04 Oct 2013 14:12

Last Modified:

27 Feb 2024 14:29

Publisher DOI:

10.1016/j.ahj.2011.01.025

PubMed ID:

21641358

Web of Science ID:

000291343000015

BORIS DOI:

10.7892/boris.2602

URI:

https://boris.unibe.ch/id/eprint/2602 (FactScience: 205334)

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