Outcomes of transcatheter aortic valve implantation in high surgical risk and inoperable patients with aortic stenosis: a single Australian Centre experience.
BACKGROUND
Degenerative aortic stenosis is the most common valvular heart disease in the elderly, and many patients are not suitable for aortic valve replacement surgery. Transcatheter aortic valve implantation (TAVI) is a new therapeutic option for selected patients at high risk for surgery.


OBJECTIVE
To evaluate the safety and efficacy of TAVI in Australian patients.


METHODS
This is a prospective study of patients undergoing TAVI for severe symptomatic aortic stenosis at The Prince Charles Hospital, Brisbane, Australia between August 2008 and July 2013. Patients were at high risk of surgical aortic valve replacement, or inoperable, as deemed by a multidisciplinary 'heart team'. Outcomes include procedural success and complications, 30-day and 1-year mortality and stroke, combined end-points as outlined by the Valve Academic Research Consortium 2 consensus document.


RESULTS
Two hundred and nine patients underwent TAVI during the study period. The mean age was 83.7 ± 6.7 years, and 101 (48%) were men. The valve systems utilised were as follows: Edwards-SAPIEN valve in 104 (49.5%), Medtronic CoreValve in 86 (41.2%) and Boston Scientific Lotus valve in 19 (9.3%) patients. Thirty-day and 1-year mortality rates were 5.7% and 11.5% respectively. Thirty-day and 1-year stroke rates were 4.3% and 6.2% respectively. The composite end-points of device success, early safety and clinical efficacy occurred in 80.4%, 27.3% and 68.4%.


CONCLUSIONS
TAVI with various valve systems, delivered through several approaches, is feasible in high surgical risk and inoperable patients with severe aortic stenosis, with acceptable outcomes at short-term and intermediate-term follow up.
Heart and Lung Institute, The Prince Charles Hospital.
V
V
Subban
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
D
D
Murdoch
Heart and Lung Institute, The Prince Charles Hospital.
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Savage
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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Crowhurst
Heart and Lung Institute, The Prince Charles Hospital.
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Saireddy
Heart and Lung Institute, The Prince Charles Hospital.
K K
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Poon
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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A
Incani
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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Bett
Heart and Lung Institute, The Prince Charles Hospital.
D J
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Burstow
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
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GM
Scalia
Heart and Lung Institute, The Prince Charles Hospital.
A
A
Clarke
Heart and Lung Institute, The Prince Charles Hospital.
O C
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Raffel
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
C N
CN
Aroney
Heart and Lung Institute, The Prince Charles Hospital.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
D L
DL
Walters
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000639:trends; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D018579:Patient Selection; D011446:Prospective Studies; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000639:trends*; D016896:Treatment Outcome
aortic valve; aortic valve stenosis; cardiology; heart disease; transcatheter aortic valve replacement