Symetis Transcatheter Aortic Bioprostheses For The Treatment Of Severe Aortic Stenosis: First North American Experience With 1-year Follow-up
Vincenzo Giambruno, Feras Khaliel, Uthman Aluthman, Michael Chu, Patrick Teefy, Pantelis Diamantouros, Rodrigo Bagur, Philip Jones, Daniel Bainbridge, Christopher Harle, Ivan Iglesias, Matt McFarking, Ramiro Arellano, David McCarty, Andrew Thain, Bob Kiaii.
London Health Sciences Centre, London Ontario, ON, Canada.
Objective: Newer generation transcatheter aortic valve prostheses introduce technological and design advantages that may improve patient outcomes. We present the initial experience with the Symetis ACURATE TAVI technology with 1-year follow-up.
Methods: From January 2014 to October 2016, 87 high surgical risk patients with symptomatic severe aortic stenosis (AS) underwent a transcatheter aortic valve implantation (TAVI) using the transapical Symetis ACURATE TA and the transfemoral Symetis ACURATE Neo devices. In-hospital and 30-day outcomes were evaluated and reported according to the Valve Academic Research Consortium-2 definitions. Clinical and echocardiographic follow-up was performed up to 1-year.
Results: The mean age was 82.4±8.1 years with a mean logistic-EuroSCORE of 16.35±11.26% and a Society of Thoracic Surgeons score of 5.3±3.8. The transapical Symetis TA was utilized in 65 patients (74.7%), the transfemoral Symetis ACURATE Neo in 22 patients (25.3%). The procedure was successful performed in 85 patients. Two patients (2.3%) required an emergency conversion to conventional cardiopulmonary bypass due to embolization of the bioprosthesis. No coronary obstruction occurred. PVL was identified in 32 patients (38.1%), and it was evaluated as mild in all these cases. The average peak gradient (PG) on the prosthetic valves was 16±8.5mmHg, the average mean gradient (MG) was 8±4.6 mmHg. 9 patients (10.5%) required a PPM implant. The mean ICU stay was 1±0.9 days, the mean hospital stay was 7±5.5 days. In-hospital mortality was 3.4% (n=3), 30-day mortality was 3.6% (n=3). At the end of the follow-up (11.5±7.6 months), 10 more patients (11.8%) died with an overall mortality of 18.4% (n=16). The majority of the patients were in NYHA class 1 (76.1%), 10.5% of the patients in NYHA 2, 11.9% of the patients in NYHA 3, and the remaining 1.4% in NYHA 4. The rate of readmission to hospital for congestive heart failure was 16.4%.
Conclusions: This initial experience shows that TAVI procedures using the Symetis ACURATE bioprosthesis can be performed safely in a selected subset of patients with comparable short-term results with other TAVI devices.
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