Current Tavi Heart Valve Prostheses - The Kiel Experience With The Transaortic And Transfemoral Approach
Katharina Huenges, Katharina Kreipe, Markus Neu, Vincent Christiansen, Georg Lutter, Jochen Cremer, Norbert Frey, Derk Frank.
UKSH Kiel, Kiel, Germany.
OBJECTIVE: Transcatheter aortic valve implantation (TAVI) has evolved as an important therapeutic option for symptomatic aortic stenosis. Since its introduction in 2012 the transaortic approach has developed as the standard surgical approach at our center. We present our experiences made with transaortic (TAo) and transfemoral (TF) approach using two current TAVI prosthesis types, the SAPIEN-3 (S3, Edwards Lifesciences) and the CoreValve Evolut-R (ER; Medtronic).
METHODS: After informed consent all TAVI patients were included in a prospective registry. Baseline demographics and medical history were collected. Periprocedural parameters were documented. Patients were followed-up including 7-days, 30-days and annual visits. Valve performance was evaluated with transthoracic echocardiography (TTE). The current Valve Academic Research Consortium (VARC)-2 criteria were applied.
RESULTS: Between 02/2014 and 09/2016 a total of 462 patients received a TAVI procedure using TF or TAo access. The S3 was used in 73.8% (n=341) and the ER in 26.2% (n=121) cases. In 67.7% (n=313) TF access was chosen and in 32.3% (n=149) TAo access for TAVI implantation. Mean age at implantation was 81±7 years in the S3 and 82±6 years in the ER group. The S3 group included more male patients (46% vs 30.6%, p=0.0037). Preoperative EuroScore-II was 7.16±6.23 (S3) and 7.21±6.33 (ER), (p=n.s.) and further cardiovascular baseline characteristics were comparable. The 7d TTE revealed no paravalvular leakage (PVL) in more patients with the S3 valve (74.5% vs 37.2%, p<0.001). Likewise mild PVLs were less frequent in the S3 group (15.5% vs 47.1%, p<0.001) as well as moderate PVLs (0.3% vs 4.1%, p=n.s.). Severe PVL did only occur in one case (ER, 0.8%). Rate of required permanent pacemaker implantations was comparable with 13.8% (S3; n=39) vs. 13.2% (ER, n=14), (p=n.s.). Life-threatening bleeding, according VARC-2 occurred in the TF in 2.9% and in 4.7% in the ER group (p=n.s.). The 30-days mortality was acceptably low with 6.5% (S3, n=22) and 4.1% (ER, n=5), (p=n.s.).
CONCLUSIONS: Our initial results with the current TAVI valves using transfemoral or transaortic approach. The occurrence of paravalvular leakages was more likely in the ER group, whereas the rate of permanent pacemakers and 30d mortality was similar within both groups.
Back to 2017 Posters