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OBJECTIVE: Severe aortic stenosis in patients deemed too high risk for surgical therapy benefit from transcatheter aortic valve implantation (TAVI). We review our two year experience with TAVI to identify risk factors associated with increased mortality.
METHODS: Forty six patients with severe aortic stenosis underwent TAVI at our institution in past 24 months. Demographics, comorbidities, echocardiographic characteristics, technical approach and postoperative complications were recorded for comparison. P-value of <0.05 was considered significant.
RESULTS: Of forty six patients with mean age of 84.5 years 45% (n=21) were females. 35% had Diabetes mellitus and 91% had Hypertension; 41%, 37% and 22% of the patients had COPD, renal insufficiency and prior stroke, respectively. 76% of the patients had coronary artery disease of which 28% had prior coronary artery bypass and 37% underwent PCI. 91% patients were NYHA class III or higher. One third of patients had a second valve pathology of at least moderate severity. Mean pulmonary systolic pressure was 48.6 mmHg with 39% patients with severe pulmonary hypertension (>50 mm Hg). Edwards Sapien valve was used in all patients. Transfemoral (26%), transapical (61%) as well as direct aortic (13%) approach was used. Rapid pacing and pre-implantation balloon dilation was carried out in all patients. 30 day mortality and 1 year mortality was 9% and 28% patients respectively.
CONCLUSIONS: Prior ischemic heart disease and stroke, degree of tricuspid regurgitation and pulmonary systolic hypertension and left ventricular dysfunction were associated with higher early mortality following TAVI.