Clinical and hemodynamic outcomes of "all-comers" undergoing transapical aortic valve implantation: Results from the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA)

被引：52

作者：

D'Onofrio, Augusto ^{[1
]}

Rubino, Paolo ^{[2
]}

Fusari, Melissa ^{[3
]}

Salvador, Loris ^{[4
]}

Musumeci, Francesco ^{[5
]}

Rinaldi, Mauro ^{[6
]}

Vitali, Ettore O. ^{[7
]}

Glauber, Mattia ^{[8
]}

Di Bartolomeo, Roberto ^{[9
]}

Alfieri, Ottavio R. ^{[10
]}

Polesel, Elvio ^{[11
]}

Aiello, Marco ^{[12
]}

Casabona, Riccardo ^{[13
]}

Livi, Ugolino ^{[14
]}

Grossi, Claudio ^{[15
]}

Cassese, Mauro ^{[16
]}

Pappalardo, Aniello ^{[17
]}

Gherli, Tiziano ^{[18
]}

Stefanelli, Guglielmo ^{[19
]}

Faggian, Giuseppe G. ^{[20
]}

Gerosa, Gino

机构：

[1] Univ Padua, Sch Med, Div Cardiac Surg, Ctr Gallucci, I-35128 Padua, Italy

[2] Clin Montevergine, Invas Cardiol Lab, Div Cardiol, Mercogliano, Italy

[3] Univ Milan, Dept Cardiovasc Sci, Ctr Cardiol Monzino, IRCCS, Milan, Italy

[4] San Bortolo Hosp, Div Cardiac Surg, Vicenza, Italy

[5] San Camillo Hosp, Dept Cardiac Surg, Rome, Italy

[6] Univ Turin, Div Cardiac Surg, Turin, Italy

[7] Humanitas Gavazzeni Hosp, Dept Cardiac Surg, Bergamo, Italy

[8] G Pasquinucci Heart Hosp, Dept Adult Cardiac Surg, Massa, Italy

[9] Univ Bologna, Dept Cardiac Surg, Bologna, Italy

[10] San Raffaele Univ Hosp, Dept Cardiac Surg, Milan, Italy

[11] Osped Angelo, Venice, Italy

[12] IRCCS Fdn S Matteo, Div Cardiac Surg, Pavia, Italy

[13] Osped Mauriziano Umberto 1, Div Cardiac Surg, Turin, Italy

[14] S Maria della Misericordia Univ Hosp, Cardiothorac Dept, Udine, Italy

[15] S Croce & Carle Hosp, Cardiovasc Dept, Cuneo, Italy

[16] Clin S Anna, Div Cardiac Surg, Catanzaro, Italy

[17] Osped Riuniti, Dept Cardiothorac Surg, Trieste, Italy

[18] Univ Parma, Div Cardiac Surg, I-43100 Parma, Italy

[19] Hesperia Hosp, Dept Cardiac Surg, Modena, Italy

[20] Univ Verona, Div Cardiac Surg, I-37100 Verona, Italy

来源：

JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY | 2011年 / 142卷 / 04期

关键词：

HIGH-RISK PATIENTS; STENOSIS; RECOMMENDATIONS; DISEASE;

D O I：

10.1016/j.jtcvs.2011.06.026

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objective: The aim of this study was to assess clinical and hemodynamic outcomes of transapical aortic valve implantation (TA-TAVI) in patients enrolled in the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). Methods: From April 2008 until November 2010, 504 patients from 20 Italian centers were enrolled in the I-TA registry. Mean logistic EuroSCORE and Society of Thoracic Surgeons score were 24% +/- 16% and 11% +/- 4%, respectively. Mean follow-up was 9.2 +/- 6.5 months (range, 1-26 months). Outcomes were analyzed according to intraoperative complications, procedural volume (high-volume centers, >20 cases; low-volume centers, <20 cases) and learning curve (first 50% cases vs second 50% cases of each center). Results: All-cause overall mortality was 8.3% (42 patients). Device success was 99% (500/504 patients). Intraoperative severe complications occurred in 24 (4.8%) patients. Overall 2-year survival was 71.5% +/- 6.2%. At discharge, peak and mean gradients were 16.4 +/- 11.2 and 8.7 +/- 4.1 mm Hg, respectively, and effective orifice area was 1.67 cm(2). These values remained stable at 3, 6, and 12 months after surgery. Independent risk factors for mortality after TA-TAVI were as follows: New York Heart Association class III and IV (odds ratio [OR], 4.43; 95% confidence intervals [CI], 1.28-15.40; P = .02); logistic EuroSCORE greater than 20 (OR, 1.83; 95% CI, 1.02-3.29; P = .04); creatinine concentration greater than 200 mu mol/L (OR, 2.56; 95% CI, 1.07-6.15; P = .03), and intraoperative complications (OR, 5.80; 95% CI, 2.68-12.55; P < .001). There were no significant differences in outcomes between high-and low-volume centers and between the first and the second 50% of cases. Conclusions: TA-TAVI represents a safe and effective alternative treatment for patients who are inoperable or at high risk for surgery. The occurrence of an intraoperative complication significantly affects survival. Procedural volume and learning curve have no impact on patient survival. (J Thorac Cardiovasc Surg 2011; 142: 768-75)

引用

页码：768 / 775

页数：8

共 18 条

[1] Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice [J].

Baumgartner, Helmut ;

Hung, Judy ;

Bermejo, Javier ;

Chambers, John B. ;

Evangelista, Arturo ;

Griffin, Brian P. ;

Iung, Bernard ;

Otto, Catherine M. ;

Pellikka, Patricia A. ;

Quinones, Miguel .

EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY, 2009, 10 (01) :1-25

[2] Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group [J].

Bellomo, R ;

Ronco, C ;

Kellum, JA ;

Mehta, RL ;

Palevsky, P .

CRITICAL CARE, 2004, 8 (04) :R204-R212

[3]

Bosman JM, 2011, INTERACT CARDIO 0224

[4] Results of Transfemoral or Transapical Aortic Valve Implantation Following a Uniform Assessment in High-Risk Patients With Aortic Stenosis [J].

Himbert, Dominique ;

Descoutures, Fleur ;

Al-Attar, Nawwar ;

Iung, Bernard ;

Ducrocq, Gregory ;

Detaint, Delphine ;

Brochet, Eric ;

Messika-Zeitoun, David ;

Francis, Fady ;

Ibrahim, Hassan ;

Nataf, Patrick ;

Vahanian, Alec .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2009, 54 (04) :303-311

[5] A prospective survey of patients with valvular heart disease in Europe:: The Euro Heart Survey on Valvular Heart Disease [J].

Iung, B ;

Baron, G ;

Butchart, EG ;

Delahaye, F ;

Gohlke-Bärwolf, C ;

Levang, OW ;

Tornos, P ;

Vanoverschelde, JL ;

Vermeer, F ;

Boersma, E ;

Ravaud, P ;

Vahanian, A .

EUROPEAN HEART JOURNAL, 2003, 24 (13) :1231-1243

[6] Recommendations for chamber quantification [J].

Lang, Roberto M. ;

Bierig, Michelle ;

Devereux, Richard B. ;

Flachskampf, Frank A. ;

Foster, Elyse ;

Pellikka, Patricia A. ;

Picard, Michael H. ;

Roman, Mary J. ;

Seward, James ;

Shanewise, Jack ;

Solomon, Scott ;

Spencer, Kirk T. ;

Sutton, Martin St. John ;

Stewart, William .

EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY, 2006, 7 (02) :79-108

[7] Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation Clinical Trials A Consensus Report From the Valve Academic Research Consortium [J].

Leon, Martin B. ;

Piazza, Nicolo ;

Nikolsky, Eugenia ;

Blackstone, Eugene H. ;

Cutlip, Donald E. ;

Kappetein, Arie Pieter ;

Krucoff, Mitchell W. ;

Mack, Michael ;

Mehran, Roxana ;

Miller, Craig ;

Morel, Marie-angele ;

Petersen, John ;

Popma, Jeffrey J. ;

Takkenberg, Johanna J. M. ;

Vahanian, Alec ;

van Es, Gerrit-Anne ;

Vranckx, Pascal ;

Webb, John G. ;

Windecker, Stephan ;

Serruys, Patrick W. .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2011, 57 (03) :253-269

[8] Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. [J].

Leon, Martin B. ;

Smith, Craig R. ;

Mack, Michael ;

Miller, D. Craig ;

Moses, Jeffrey W. ;

Svensson, Lars G. ;

Tuzcu, E. Murat ;

Webb, John G. ;

Fontana, Gregory P. ;

Makkar, Raj R. ;

Brown, David L. ;

Block, Peter C. ;

Guyton, Robert A. ;

Pichard, Augusto D. ;

Bavaria, Joseph E. ;

Herrmann, Howard C. ;

Douglas, Pamela S. ;

Petersen, John L. ;

Akin, Jodi J. ;

Anderson, William N. ;

Wang, Duolao ;

Pocock, Stuart .

NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (17) :1597-1607

[9] Transapical Aortic Valve Implantation in 175 Consecutive Patients Excellent Outcome in Very High-Risk Patients [J].

Pasic, Miralem ;

Unbehaun, Axel ;

Dreysse, Stephan ;

Drews, Thorsten ;

Buz, Semih ;

Kukucka, Marian ;

Mladenow, Alexander ;

Gromann, Tom ;

Hetzer, Roland .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 56 (10) :813-820

[10] Transcatheter Aortic Valve Implantation for the Treatment of Severe Symptomatic Aortic Stenosis in Patients at Very High or Prohibitive Surgical Risk Acute and Late Outcomes of the Multicenter Canadian Experience [J].

Rodes-Cabau, Josep ;

Webb, John G. ;

Cheung, Anson ;

Ye, Jian ;

Dumont, Eric ;

Feindel, Christopher M. ;

Osten, Mark ;

Natarajan, Madhu K. ;

Velianou, James L. ;

Martucci, Giuseppe ;

DeVarennes, Benoit ;

Chisholm, Robert ;

Peterson, Mark D. ;

Lichtenstein, Samuel V. ;

Nietlispach, Fabian ;

Doyle, Daniel ;

DeLarochelliere, Robert ;

Teoh, Kevin ;

Chu, Victor ;

Dancea, Adrian ;

Lachapelle, Kevin ;

Cheema, Asim ;

Latter, David ;

Horlick, Eric .

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2010, 55 (11) :1080-1090

← 1 2 →