title: Early and late outcomes after trans-catheter aortic valve implantation in patients with previous chest radiation.
abstract: Surgery for aortic stenosis in patients with thoracic radiation therapy is associated with high morbi-mortality. Trans-catheter aortic valve implantation (TAVI) represents an alternative but has never been studied in this population. We aimed to compare outcomes in radiation and matched control patients undergoing TAVI and to identify predictive factors of survival.
  
  
  
  Between 2006 and 2011, 288 consecutive patients underwent TAVI in our institution, of whom 26 had previous chest radiation. They were matched 1:1 for age, sex and TAVI approach with controls.
  
  
  
  In both groups, median age was 73 years, 50% of patients were male and 15% had a transapical approach. Procedural success was 88% in the radiation group versus 100% in controls (p<0.001) and 30-day survival was 92% in both groups. Five-year survival was 33%±10% in the radiation group and 42%±11% in controls (p=0.26). In radiation patients, the main cause of death was respiratory insufficiency in 40%. We identified four independent predictive factors of death in the radiation group: extracardiac arteriopathy (p=0.002) and the absence of β-blocker therapy (p=0.005) as preprocedural variables, and infectious complications (p=0.009) and a higher peak creatinine level (p=0.009) as postprocedural variables. In the radiation group, 89% of survivors were in New York Heart Association class I-II at last follow-up.
  
  
  
  Patients in the radiation group displayed high mortality rates although not significantly different from the controls. Respiratory failure was the main cause of death, emphasising the need for a careful pulmonary evaluation. Finally, we show a sustained improvement in functional results after TAVI in this population.
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France Faculté de Médecine Paris-Diderot University, Paris, France DHU Fire, Paris-Diderot University, Paris, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Bouleti
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Myriam
authors.identifier: 0000-0003-4821-5249
authors.initials: M
authors.lastname: Amsallem
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France Faculté de Médecine Paris-Diderot University, Paris, France DHU Fire, Paris-Diderot University, Paris, France.
authors.forename: Aziza
authors.initials: A
authors.lastname: Touati
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France DHU Fire, Paris-Diderot University, Paris, France INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France Faculté de Médecine Paris-Diderot University, Paris, France DHU Fire, Paris-Diderot University, Paris, France INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Bernard
authors.identifier: 0000-0002-9127-348X
authors.initials: B
authors.lastname: Iung
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alos
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France DHU Fire, Paris-Diderot University, Paris, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Brochet
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France DHU Fire, Paris-Diderot University, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Urena
authors.affiliation: Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Walid
authors.initials: W
authors.lastname: Ghodbane
authors.affiliation: Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Phalla
authors.initials: P
authors.lastname: Ou
authors.affiliation: Department of Anaesthesiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dilly
authors.affiliation: Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Nataf
authors.affiliation: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France Faculté de Médecine Paris-Diderot University, Paris, France DHU Fire, Paris-Diderot University, Paris, France INSERM U1148 Bichat Hospital, Paris, France.
authors.forename: Alec
authors.initials: A
authors.lastname: Vahanian
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000150:complications*; D012131:Respiratory Insufficiency / Q000209:etiology; D016019:Survival Analysis; D013909:Thorax / Q000528:radiation effects*; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome