Failure Is Fatal - Which Determinants Of Outcome Remain In Transcatheter Aortic Valve Implantation?
Markus G. Mach1, Manuel Wilbring2, Bernhard Winkler1, Konstantin Alexiou2, Utz Kappert2, Martin Grabenwöger1, Klaus Matschke2.
1Hospital Hietzing, Vienna, Austria, 2University Heart Center Dresden, Dresden, Germany.
Objectives TAVI has advanced to a viable treatment option in high risk patients presenting with aortic valve stenosis. To the present, detailed knowledge about factors predisposing adverse outcomes of this high-risk subgroups remain scarce. The present study gives a detailed analysis of a large TAVI cohort. Patients and Methods Since 2009 a total of consecutive 1.861 patients underwent TAVI in both study centers. Mean patient's age was 80.8 +/- 5.6. Common risk scores confirmed a predominantly high-risk subgroup (EuroSCORE 20.0 +/- 14%; EuroSCORE II 7+/- 5%). The majority of the patients were female (58.2%). Patient's baselines were characterized by a broad spectrum of relevant comorbidities, such as chronic kidney disease (33.9%), COPD (9.3%), extracardiac arteriopathy (21.3%), pulmonary hypertension (14.3%) and diabetes (32.3%). Mean follow-up was 2.92 years, ranging up to 6.8 years. Data were retrospectively analyzed out of the hospital's database. An uni- and multivariate analysis for risk factors for mortality during primary hospital-stay and further follow-up was performed. Results Hospital mortality was 4.1%. Survival rates for 1-, 2- and 5-years were ⋯ . Univariate risk factors for hospital mortality were LV-EF <30% (p=0.03), extracardiac arteriopathy (p=0.023), chronic kidney disease (p=0.002), postoperative LCOS (p<0.01), re-exploration (p<0.01), respiratory failure (p<0.01), postoperative stroke (p<0.01), postoperative delirium (p<0.01), CVVH (p<0.01), prolonged ventilation (p<0.01), transfusion (p<0.01), prolonged ICU-stay (p<0.01), postoperative stroke (p<0.01). After multivariate analysis respiratory failure needing reintubation (HR 2.3 +/- 0.4; p<0.01), postoperative stroke (HR 1.4 +/- 0.6; p=0.02) and postoperative renal failure needing CVVH (HR 1.1 +/- 0.4; p<0.01) remained as factors for hospital mortality. Univariate risk factors for mortality during follow-up of the hospital survivors were pulmonary hypertension (p<0.01), COPD (p=0.02), postoperative stroke (p<0.01), postoperative CVVH (p<0.01), transfusion (p<0.01), postoperative respiratory failure needing reintubation (p<0.01), postoperative stroke (p<0.01). After multivariate analysis pulmonary hypertension (HR 2.8 +/- 0.2; p<0.01) and postoperative stroke (HR 1.7 +/- 0.7; p=0.02) remained as significant factors for mortality during follow-up. Conclusions Hospital mortality of TAVI-patients is decoupled from patients baseline characteristics. Significant factors for hospital mortality mainly were generated out of post-procedural complications. Different patterns were observed for long-term survival. Regarding the hospital survivors, patients with pulmonary hypertension or post-procedural stroke had inferior outcome. Generally, TAVI provides good results in this particular high risk subgroup. Further investigations are needed to clearly identify patients benefiting or not-benefiting from TAVI.
Back to 2018 ePosters