Patients with aortic stenosis referred for TAVI: treatment decision, in-hospital outcome and determinants of survival.
Neth Heart J
; 20(1): 16-23, 2012 Jan.
Article
en En
| MEDLINE
| ID: mdl-22167520
ABSTRACT
AIMS:
To assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI.METHODS:
Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium.RESULTS:
Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and medical therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient preference (29%), peripheral vascular disease (15%) and non-severe aortic stenosis (11%). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10%, p = 0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24% after TAVI and 8 and 25% after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, p < 0.001). Multivariable analysis revealed that blood transfusion (HR 1.19; 95% CI 1.05-1.33), pre-existing renal failure (HR 1.18; 95% CI 1.06-1.33) and STS score (HR 1.06; 95% CI 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR 3-23) months after TAVI.CONCLUSIONS:
Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.
Texto completo:
1
Bases de datos:
MEDLINE
Tipo de estudio:
Observational_studies
/
Prognostic_studies
Idioma:
En
Revista:
Neth Heart J
Año:
2012
Tipo del documento:
Article
País de afiliación:
Países Bajos