Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes.
BACKGROUND
Transcatheter aortic valve implantation is an alternative to open heart surgery in patients with aortic stenosis. However, long-term data on a programmatic approach to aortic valve implantation remain sparse.


RESULTS
Transcatheter aortic valve implantation was performed in 168 patients (median age, 84 years) in the setting of severe aortic stenosis and high surgical risk. Access was transarterial (n=113) or, in the presence of small iliofemoral artery diameter, transapical (n=55). The overall success rate was 94.1% in this early experience. Intraprocedural mortality was 1.2%. Operative (30-day) mortality was 11.3%, lower in the transarterial group than the transapical group (8.0% versus 18.2%; P=0.07). Overall mortality fell from 14.3% in the initial half to 8.3% in the second half of the experience, from 12.3% to 3.6% (P=0.16) in transarterial patients and from 25% to 11.1% (P=0.30) in transapical patients. Functional class improved over the 1-year postprocedure period (P<0.001). Survival at 1 year was 74%. The bulk of late readmission and mortality was not procedure or valve related but rather was due to comorbidities. Paravalvular regurgitation was common but generally mild and remained stable at late follow-up. At a maximum of >3 years and a median of 221 days, structural valve failure was not observed.


CONCLUSIONS
Transcatheter aortic valve implantation can result in early and sustained functional improvement in high-risk aortic stenosis patients. Late outcome is determined primarily by comorbidities unrelated to aortic valve disease.
Webb
John G
JG
St. Paul's Hospital, 1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada. webb@providencehealth.bc.ca
Altwegg
Lukas
L
Boone
Robert H
RH
Cheung
Anson
A
Ye
Jian
J
Lichtenstein
Samuel
S
Lee
May
M
Masson
Jean Bernard
JB
Thompson
Christopher
C
Moss
Robert
R
Carere
Ron
R
Munt
Brad
B
Nietlispach
Fabian
F
Humphries
Karin
K
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization; D002423:Cause of Death; D015897:Comorbidity; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors