Survival and predictive factors of mortality after 30 days in patients treated with percutaneous implantation of the CoreValve aortic prosthesis

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• 作者：Antonio J. Muñ ; oz-Garcí ; a ; MD ; PhD^a ; ^{ajmunozgarcia@secardiologia.es} ; José ; M. Hern&#225 ; ndez-Garcí ; a ; MD ; PhD^a ; Manuel F. Jimé ; nez-Navarro ; MD ; PhD^a ; Juan H. Alonso-Briales ; MD^a ; Antonio J. Domí ; nguez-Franco ; MD^a ; Isabel Rodrí ; guez-Bailó ; n ; MD^a ; Marí ; a J. Molina-Mora ; MD^a ; Paula Hern&#225 ; ndez-Rodrí ; guez ; MD^b ; Miguel Such-Martí ; nez ; MD^c ; Eduardo de Teresa-Galv&#225 ; n ; MD ; PhD^a
• 刊名：American Heart Journal
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：163
• 期：2
• 页码：288-294
• 全文大小：292 K

文摘

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Background

Few data exist on the clinical impact of transcatheter aortic valve implantation (TAVI) in patients with symptomatic aortic stenosis and a high surgical risk. The aim of this study was to determine the survival and the factors predicting mortality after 30 days post-TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN).

Methods

From April 2008 to October 2010, the CoreValve prosthesis (Medtronic) was implanted in 133 consecutive high-risk surgical patients with symptomatic severe aortic stenosis.

Results

The mean age was 79.5 ¡À 6.7 years. The logistic European System for Cardiac Operative Risk Evaluation was 21.5 % ¡À 14 % . The implantation success rate was 97.7 % . In-hospital mortality was 4.5 % , and the combined end point of death, vascular complications, myocardial infarction, or stroke had a rate of 9 % . Survival at 12 and 24 months was 84.5 % and 79 % , respectively, after a mean follow-up of 11.3 ¡À 8 months. The New York Heart Association functional class improved from 3.3 ¡À 0.5 to 1.18 ¡À 0.4 and remained stable at 1 year. A high Charlson index (hazard ratio [HR] 1.44, 95 % CI 1.09-1.89, P < .01) and a worse Karnofsky score before the procedure (HR 0.95, 95 % CI 0.92-0.99, P = .021) were predictors of mortality after 30 days.

Conclusions

Transcatheter aortic valve implantation with the CoreValve prosthesis for patients with aortic stenosis and a high surgical risk is a safe, efficient option resulting in a medium-term clinical improvement. Survival during follow-up depends on the associated comorbidities. Early mortality beyond 30 days is predicted by preoperative comorbidity scores and the functional status of the patient.