Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation

Wenaweser, Peter; Stortecky, Stefan; Schwander, Sarah; Heg, Dik; Huber, Christoph; Pilgrim, Thomas; Gloekler, Steffen; O'Sullivan, Crochan J.; Meier, Bernhard; Jüni, Peter; Carrel, Thierry; Windecker, Stephan (2013). Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation. European Heart Journal, 34(25), pp. 1894-1905. Oxford: Oxford University Press 10.1093/eurheartj/eht086

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AimsTranscatheter aortic valve implantation (TAVI) is an established treatment alternative to surgical aortic valve replacement in high-risk and inoperable patients and outcomes among patients with estimated low or intermediate risk remain to be determined. The aim of this study was to assess clinical outcomes among patients with estimated low or intermediate surgical risk undergoing TAVI.Methods and resultsBetween August 2007 and October 2011, 389 consecutive patients underwent TAVI and were categorized according to the Society of Thoracic Surgeons (STS) score into low (STS < 3%; n = 41, 10.5%), intermediate (STS ≥3% and ≤8%, n = 254, 65.3%), and high-risk (STS > 8%; n = 94, 24.2%) groups for the purpose of this study. Significant differences were found between the groups (low risk vs. intermediate risk vs. high risk) for age (78.2 ± 6.7 vs. 82.7 ± 5.7 vs. 83.7 ± 4.9, P < 0.001), body mass index (28.1 ± 6.1 vs. 26.5 ± 4.9 vs. 24.4 ± 4.6, P < 0.001), chronic renal failure (34 vs. 67 vs. 90%, P < 0.001), all-cause mortality at 30 days (2.4 vs. 3.9 vs. 14.9%, P = 0.001), and all-cause mortality at 1 year (10.1 vs. 16.1 vs. 34.5%, P = 0.0003). No differences were observed with regards to cerebrovascular accidents and myocardial infarction during 1-year follow-up.ConclusionIn contemporary practice, TAVI is not limited to inoperable or STS-defined high-risk patients and should be guided by the decision of an interdisciplinary Heart Team. Compared with patients at calculated high risk, well-selected patients with STS-defined intermediate or low risk appear to have favourable clinical outcomes.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Wenaweser, Peter Martin; Stortecky, Stefan; Heg, Dierik Hans; Huber, Christoph; Pilgrim, Thomas; Glökler, Steffen; O'Sullivan, Crochan John; Meier, Bernhard; Jüni, Peter; Carrel, Thierry and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:37

Last Modified:

27 Apr 2018 10:06

Publisher DOI:

10.1093/eurheartj/eht086

PubMed ID:

23487519

Web of Science ID:

000302133800111

Additional Information:

Wenaweser and Stortecky contributed equally to this work.

Uncontrolled Keywords:

Aortic stenosis, Intermediate risk, Risk stratification, TAVI, Transcatheter aortic valve implantation

BORIS DOI:

10.7892/boris.14925

URI:

https://boris.unibe.ch/id/eprint/14925 (FactScience: 222067)

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