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Mid- to Long-term Outcomes After Transcatheter Aortic Valve Implantation
Shahram Lotfi1, Guido Dohmen2, Andreas Götzenich1, Marcus Haushofer1, Jan Spillner1, Rüdiger Autschbach1, Rainer Hoffmann3.
1Department of Thoracic and Cardiovascular Surgery, RWTH University Clinics Aachen, Aachen, Germany, 2Department of Cardiac, Thoracic and Vascular Surgery, St.-Johannes-Hospital, Dortmund, Germany, 3Department of Cardiology, RWTH University Clinics Aachen, Aachen, Germany.

OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or non-operable patients with severe symptomatic aortic valve stenosis. The best known and most frequently implanted prostheses are CoreValve® and SAPIEN® prostheses. We report our experiences and analyze the results of our TAVI program.
METHODS: 367 patients underwent TAVI in our centre between January 2008 and October 2012. The procedure was performed in 197 patients with CoreValve®, in 158 patients with SAPIEN® and in 12 Patients with ACURATE TA® prostheses. Transfemoral (TF) access was used in 190 Patients. In 167 patients transapical (TA) access was used. Transaortic and transsubclavian access were chosen in 8 and 2 patients. The mean age was 80.6 ± 6.4 years. All patients were non-operable or had a high risk for a conventional aortic valve replacement. The mean logistic EuroScore was 25.32±14.51%. The TF/CoreValve® (190 patients) and TA/SAPIEN® (155 patients) groups showed no significant difference in patients mean age (81.7±6.3 years vs. 79.5±6.6 years) but a significant difference in mean logistic EuroScore (22.16±13.05% vs. 31.04±16.40, p<0001).
RESULTS: Overall-30d-Mortality (367patients): 9.54% (TF 8.42%, TA 11.31%). Overall-1Y-Mortality (275patients): 21.45% (TF 23.74%, TA 19.12%). Overall-2Y-Mortality (199patients): 29.15% (TF 35.96%, TA 23.64%). Overall-3Y-Mortality (133patients): 37.59% (TF 43.86%, TA 32.89%). Overall-4Y-Mortality (38patients): 39.47% (TF 45%, TA 33.33%). The rate of pacemaker implantation after TAVI was in CoreValve®-group significantly higher than in SAPIEN®-group: 45.17% (89 of 193patients) vs. 6.33% (10 of 158patients) p<0001. Stroke rate was in TF-CoreValve®-group higher than in TA-SAPIEN®-group: 4.21% vs. 0.064%, p=0.045.
CONCLUSIONS: Outcomes after TAVI were in our population of non-operable and high-risk patients encouraging. The differences in mid- and long-term outcomes between TF-CoreValve®-TAVI and TA-SAPIEN®-TAVI were not significant, but showed a tendency in advantage of TA-group. The learning curve included not only peri- and intraoperative, but also pre- and postoperative improvements in treating of this special group of high-risk patients.


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