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Int J Cardiol. 2013 Aug 10;167(3):687-92. doi: 10.1016/j.ijcard.2012.03.066. Epub 2012 Mar 27.

Early and mid-term cardiovascular outcomes following TAVI: impact of pre-procedural transvalvular gradient.

Author information

1
Department of Cardiology, Centre Marie Lannelongue, Le Plessis-Robinson, France. n.amabile@ccml.fr

Abstract

OBJECTIVE:

To assess the relation of aortic transvalvular gradient with outcomes following transcatheter aortic valve implantation (TAVI).

BACKGROUND:

Relatively little is known about the predictors of adverse outcomes in patients with severe aortic stenosis following TAVI.

METHODS:

We studied 126 consecutive patients (mean age 83.2 ± 6.3 years; 59% women) who underwent TAVI (23% transapical; 77% transfemoral) at our institution. All patients were followed for the incidence of major adverse cardiovascular events (MACE), including myocardial infarction, heart failure, stroke, and cardiovascular death.

RESULTS:

The acute procedural success rate was 98%; at 1 year, the cumulative incidence of MACE and cardiovascular death was 29% and 10%, respectively. In multivariable analyses adjusting for clinical and echocardiographic risk factors, presence of a baseline mean transvalvular gradient (MTG) <40 mmHg was a significant predictor of 30-day MACE in the total sample (OR 4.4, 95% CI 1.7-11.4; P=0.003) as well as in patients with an ejection fraction ≥ 50% (OR 10.3, 95% CI 3.0-33.4; P<0.001). In multivariable analyses, low MTG was also associated with 2-fold and 4-fold increased hazards for MACE (HR 4.2, 95% CI 2.0-8.9; P<0.001) and cardiovascular death (HR 4.2 95% CI 1.2-14.9; P=0.03), respectively, within 1 year following TAVI.

CONCLUSION:

Presence of a low MTG (<40 mmHg) prior to TAVI was associated with a greater risk of major adverse events, including cardiovascular death, up to 1 year following the procedure. Pre-procedural MTG could be used to identify patients at a high risk for adverse outcomes following TAVI.

KEYWORDS:

Aortic stenosis; Outcomes; Transcatheter aortic valve implantation

PMID:
22459396
DOI:
10.1016/j.ijcard.2012.03.066
[Indexed for MEDLINE]

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