Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis

摘要

Introduction Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access. Aim: To assess early- and mid-term clinical outcomes after TA-TAVI. Material and methods Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed. Results Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0–84.0) years; 55.7% were males. Median baseline EuroSCORE I?and STS scores were 18.2% (11.6–27.7) and 4.8% (3.3–8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15–8.76: p = 0.026; RR for AVA per 0.1?cm2 1.28, 95% CI: 1.03–1.55: p = 0.024; RR for GFR per 1?ml/min 0.96: 95% CI: 0.94–0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01–1.17: p = 0.033; RR for RVSP per 1?mm Hg 1.07: 95% CI 1.02–1.16: p = 0.011). Conclusions Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.