Document Detail


Transcatheter aortic valve implantation: durability of clinical and hemodynamic outcomes beyond 3 years in a large patient cohort.
MedLine Citation:
PMID:  20837893     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although short- and medium-term outcomes after transcatheter aortic valve implantation are encouraging, long-term data on valve function and clinical outcomes are limited.
METHODS AND RESULTS: Consecutive high-risk patients who had been declined as surgical candidates because of comorbidities but who underwent successful transcatheter aortic valve implantation with a balloon-expandable valve between January 2005 and December 2006 and survived past 30 days were assessed. Clinical, echocardiographic, and computed tomographic follow-up examinations were performed. Seventy patients who underwent successful procedures and survived longer than 30 days were evaluated at a minimum follow-up of 3 years. At a median follow-up of 3.7 years (interquartile range 3.4 to 4.3 years), survival was 57%. Survival at 1, 2, and 3 years was 81%, 74%, and 61%, respectively. Freedom from reoperation was 98.5% (1 patient with endocarditis). During this early procedural experience, 11 patients died within 30 days, and 8 procedures were unsuccessful. When these patients were included, overall survival was 51%. Transaortic pressure gradients increased from 10.0 mm Hg (interquartile range 8.0 to 12.0 mm Hg) immediately after the procedure to 12.1 mm Hg (interquartile range 8.6 to 16.0 mm Hg) after 3 years (P=0.03). Bioprosthetic valve area decreased from a mean of 1.7±0.4 cm(2) after the procedure to 1.4±0.3 cm(2) after 3 years (P<0.01). Aortic incompetence after implantation was trivial or mild in 84% of cases and remained unchanged or improved over time. There were no cases of structural valvular deterioration, stent fracture, deformation, or valve migration.
CONCLUSIONS: Transcatheter aortic valve implantation demonstrates good medium- to long-term durability and preserved hemodynamic function, with no evidence of structural failure. The procedure appears to offer an adequate and lasting resolution of aortic stenosis in selected patients.
Authors:
R Gurvitch; D A Wood; E L Tay; J Leipsic; J Ye; S V Lichtenstein; C R Thompson; R G Carere; N Wijesinghe; F Nietlispach; R H Boone; S Lauck; A Cheung; J G Webb
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Publication Detail:
Type:  Journal Article     Date:  2010-09-13
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-09-29     Completed Date:  2010-10-18     Revised Date:  2010-12-10    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1319-27     Citation Subset:  AIM; IM    
Affiliation:
St Paul's Hospital, 1081 Burrard St, Vancouver, British Columbia, Canada V6Z 1Y6. john.webb@vch.ca
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MeSH Terms
Descriptor/Qualifier:
Aged, 80 and over
Aortic Valve Stenosis / mortality,  surgery*
Cohort Studies
Follow-Up Studies
Heart Valve Prosthesis Implantation* / adverse effects
Hemodynamics*
Humans
Survival Rate
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Comments/Corrections
Comment In:
Nat Rev Cardiol. 2010 Dec;7(12):663

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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