Survival and predictive factors of mortality after 30 days in patients treated with percutaneous implantation of the CoreValve aortic prosthesis.
BACKGROUND
Few data exist on the clinical impact of transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis and a high surgical risk. The aim of this study was to determine the survival and the factors predicting mortality after 30 days post-TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN).


METHODS
From April 2008 to October 2010, the CoreValve prosthesis (Medtronic) was implanted in 133 consecutive high-risk surgical patients with symptomatic severe aortic stenosis.


RESULTS
The mean age was 79.5 ± 6.7 years. The logistic European System for Cardiac Operative Risk Evaluation was 21.5% ± 14%. The implantation success rate was 97.7%. In-hospital mortality was 4.5%, and the combined end point of death, vascular complications, myocardial infarction, or stroke had a rate of 9%. Survival at 12 and 24 months was 84.5% and 79%, respectively, after a mean follow-up of 11.3 ± 8 months. The New York Heart Association functional class improved from 3.3 ± 0.5 to 1.18 ± 0.4 and remained stable at 1 year. A high Charlson index (hazard ratio [HR] 1.44, 95% CI 1.09-1.89, P < .01) and a worse Karnofsky score before the procedure (HR 0.95, 95% CI 0.92-0.99, P = .021) were predictors of mortality after 30 days.


CONCLUSIONS
Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient.
Department of Cardiology, Virgen de la Victoria Clinical University Hospital, Málaga, Spain. ajmunozgarcia@secardiologia.es
Antonio J
AJ
Muñoz-García
José M
JM
Hernández-García
Manuel F
MF
Jiménez-Navarro
Juan H
JH
Alonso-Briales
Antonio J
AJ
Domínguez-Franco
Isabel
I
Rodríguez-Bailón
María J
MJ
Molina-Mora
Paula
P
Hernández-Rodríguez
Miguel
M
Such-Martínez
Eduardo
E
de Teresa-Galván
D000368:Aged; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011379:Prognosis; D011474:Prosthesis Design; D012307:Risk Factors; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome