PMID- 22885336
OWN - NLM
STAT- MEDLINE
DCOM- 20131118
LR  - 20130409
IS  - 1873-734X (Electronic)
IS  - 1010-7940 (Linking)
VI  - 43
IP  - 5
DP  - 2013 May
TI  - Transapical aortic valve replacement in extreme-risk patients: outcome, risk 
      factors and mid-term results.
PG  - 978-85
LID - 10.1093/ejcts/ezs458 [doi]
AB  - OBJECTIVES: Transcatheter aortic valve replacement (TAVR) provides good results 
      in selected high-risk patients. However, it is unclear whether this procedure 
      carries advantages in extreme-risk profile patients with logistic EuroSCORE above 
      35%. METHODS: From January 2009 to July 2011, of a total number of 92 
      transcatheter aortic valve procedures performed, 40 'extreme-risk' patients 
      underwent transapical TAVR (TA-TAVR) (EuroSCORE above 35%). Variables were 
      analysed as risk factors for hospital and mid-term mortality, and a 2-year 
      follow-up (FU) was obtained. RESULTS: The mean age was: 81 +/- 10 years. Twelve 
      patients (30%) had chronic pulmonary disease, 32 (80%) severe peripheral vascular 
      disease, 14 (35%) previous cardiac surgery, 19 (48%) chronic renal failure (2 in 
      dialysis), 7 (17%) previous stroke (1 with disabilities), 3 (7%) a porcelain 
      aorta and 12 (30%) were urgent cases. Mean left ventricle ejection fraction 
      (LVEF) was 49 +/- 13%, and mean logistic EuroSCORE was 48 +/- 11%. Forty stent-valves 
      were successfully implanted with six Grade-1 and one Grade-2 paravalvular 
      leakages (success rate: 100%). Hospital mortality was 20% (8 patients). Causes of 
      death following the valve academic research consortium (VARC) definitions were: 
      life-threatening haemorrhage (1), myocardial infarction (1), sudden death (1), 
      multiorgan failure (2), stroke (1) and severe respiratory dysfunction (2). Major 
      complications (VARC definitions) were: myocardial infarction for left coronary 
      ostium occlusion (1), life-threatening bleeding (2), stroke (2) and acute kidney 
      injury with dialysis (2). Predictors for hospital mortality were: conversion to 
      sternotomy, life-threatening haemorrhage, postoperative dialysis and long 
      intensive care unit (ICU) stay. Variables associated with hospital mortality 
      were: conversion to sternotomy (P = 0.03), life-threatening bleeding (P = 0.02), 
      acute kidney injury with dialysis (P = 0.03) and prolonged ICU stay (P = 0.02). 
      Mean FU time was 24 months: actuarial survival estimates for all-cause mortality 
      at 6 months, 1 year, 18 months and 2 years were 68, 57, 54 and 54%, respectively. 
      Patients still alive at FU were in good clinical condition, New York Heart 
      Association (NYHA) class 1-2 and were never rehospitalized for cardiac 
      decompensation. CONCLUSIONS: TA-TAVR in extreme-risk patients carries a moderate 
      risk of hospital mortality. Severe comorbidities and presence of residual 
      paravalvular leakages affect the mid-term survival, whereas surviving patients 
      have an acceptable quality of life without rehospitalizations for cardiac 
      decompensation.
FAU - Ferrari, Enrico
AU  - Ferrari E
AD  - Department of Cardiac Surgery, University Hospital of Lausanne, Lausanne, 
      Switzerland. enricoferrari@bluewin.ch
FAU - Namasivayam, Jegaruban
AU  - Namasivayam J
FAU - Marcucci, Carlo
AU  - Marcucci C
FAU - Gronchi, Fabrizio
AU  - Gronchi F
FAU - Berdajs, Denis
AU  - Berdajs D
FAU - Niclauss, Lars
AU  - Niclauss L
FAU - von Segesser, Ludwig Karl
AU  - von Segesser LK
LA  - eng
PT  - Journal Article
DEP - 20120811
PL  - Germany
TA  - Eur J Cardiothorac Surg
JT  - European journal of cardio-thoracic surgery : official journal of the European 
      Association for Cardio-thoracic Surgery
JID - 8804069
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/*surgery
MH  - Aortic Valve Stenosis/*surgery
MH  - Echocardiography
MH  - Female
MH  - *Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Middle Aged
MH  - Multivariate Analysis
MH  - Postoperative Complications
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
EDAT- 2012/08/14 06:00
MHDA- 2013/11/19 06:00
CRDT- 2012/08/14 06:00
PHST- 2012/08/14 06:00 [entrez]
PHST- 2012/08/14 06:00 [pubmed]
PHST- 2013/11/19 06:00 [medline]
AID - ezs458 [pii]
AID - 10.1093/ejcts/ezs458 [doi]
PST - ppublish
SO  - Eur J Cardiothorac Surg. 2013 May;43(5):978-85. doi: 10.1093/ejcts/ezs458. Epub 
      2012 Aug 11.