Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2013
Standalone balloon aortic valvuloplasty: indications and outcomes from the UK in the transcatheter valve era.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Khawaja Muhammed Z, Sohal Manav, Valli Haseeb, Dworakowski Rafal, Pettit Stephen J, Roy David, Newton James, Schneider Heiko, Manoharan Ganesh, Doshi Sagar, Muir Douglas, Roberts David, Nolan James, Gunning Mark, Densem Cameron, Spence Mark S, Chowdhary Saqib, Mahadevan Vaikom S, Brecker Stephen J, Maccarthy Philip, Mullen Michael, Stables Rodney H, Prendergast Bernard D, de Belder Adam, Thomas Martyn, Redwood Simon, Hildick-Smith David
Аннотация
OBJECTIVES: We sought to characterize UK-wide balloon aortic valvuloplasty (BAV) experience in the TAVI era.
BACKGROUND: BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).
METHODS: Data from 423 patients at 14 centers across the UK were analyzed.
RESULTS: Patients were aged 80.9 ± 9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3% ± 16.8%. Mean peak transaortic gradient fell from 62.0 ± 26.3 to 28.3 ± 16.2 mm Hg. Aortic valve area increased from 0.58 ± 0.19 to 0.80 ± 0.25 cm(2) echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥ 2 U (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%), and permanent pacemaker (0.2%). Mortality was 13.8% at 30 days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR 1.53, 95%CI 1.08-2.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.09-2.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.18-2.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27-6.08; P < 0.0001).
CONCLUSION: Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.
BACKGROUND: BAV for acquired calcific aortic stenosis is in a phase of renaissance, largely due to the development of transcatheter aortic valve implantation (TAVI).
METHODS: Data from 423 patients at 14 centers across the UK were analyzed.
RESULTS: Patients were aged 80.9 ± 9.5 years; 52.5% were male. Mean logistic EuroScore was 27.3% ± 16.8%. Mean peak transaortic gradient fell from 62.0 ± 26.3 to 28.3 ± 16.2 mm Hg. Aortic valve area increased from 0.58 ± 0.19 to 0.80 ± 0.25 cm(2) echocardiographically. Procedural complication rate was 6.3%, comprising death (2.4%), blood transfusion ≥ 2 U (1.2%), cardiac tamponade (1.0%), stroke (1.0%), vascular surgical repair (1.0%), coronary embolism (0.5%), and permanent pacemaker (0.2%). Mortality was 13.8% at 30 days and 36.3% at 12 months. Subsequently, 18.3% of patients underwent TAVI and 7.0% sAVR, with improved survival compared to those who had no further intervention (logrank < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that survival was adversely effected by the presence of coronary artery disease (HR 1.53, 95%CI 1.08-2.17, P = 0.018), poor LV function (HR 1.54, 95%CI 1.09-2.16, P = 0.014), and either urgent (HR 1.70, 95%CI 1.18-2.45; P = 0.004) or emergent presentation (HR 3.72, 95%CI 2.27-6.08; P < 0.0001).
CONCLUSION: Balloon aortic valvuloplasty offers good immediate hemodynamic efficacy at an acceptable risk of major complications. Medium-term prognosis is poor in the absence of definitive therapy.
Предметные рубрики MeSH
AgedAged, 80 and overAortic ValveAortic Valve StenosisBalloon ValvuloplastyCalcinosisCardiac CatheterizationChi-Square DistributionFemaleHeart Valve Prosthesis ImplantationHemodynamicsHumansKaplan-Meier EstimateLogistic ModelsMaleMiddle AgedMultivariate AnalysisProportional Hazards ModelsRetrospective StudiesRisk AssessmentRisk FactorsTreatment OutcomeUnited Kingdom