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Early and late outcomes after trans-catheter aortic valve implantation in patients with previous chest radiation
  1. Claire Bouleti1,2,3,
  2. Myriam Amsallem1,
  3. Aziza Touati1,2,3,
  4. Dominique Himbert1,3,4,
  5. Bernard Iung1,2,3,4,
  6. Benjamin Alos1,
  7. Eric Brochet1,3,
  8. Marina Urena1,3,
  9. Walid Ghodbane5,
  10. Phalla Ou6,
  11. Marie-Pierre Dilly7,
  12. Patrick Nataf5,
  13. Alec Vahanian1,2,3,4
  1. 1Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
  2. 2Faculté de Médecine Paris-Diderot University, Paris, France
  3. 3DHU Fire, Paris-Diderot University, Paris, France
  4. 4INSERM U1148 Bichat Hospital, Paris, France
  5. 5Department of Cardiac Surgery, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
  6. 6Department of Radiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
  7. 7Department of Anaesthesiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
  1. Correspondence to Dr Claire Bouleti, Department of Cardiology, Bichat Hospital, 46 Rue Henri Huchard, Paris 75018, France; claire.bouleti{at}bch.aphp.fr, claire.bouleti{at}gmail.com

Abstract

Objective Surgery for aortic stenosis in patients with thoracic radiation therapy is associated with high morbi-mortality. Trans-catheter aortic valve implantation (TAVI) represents an alternative but has never been studied in this population. We aimed to compare outcomes in radiation and matched control patients undergoing TAVI and to identify predictive factors of survival.

Methods Between 2006 and 2011, 288 consecutive patients underwent TAVI in our institution, of whom 26 had previous chest radiation. They were matched 1:1 for age, sex and TAVI approach with controls.

Results In both groups, median age was 73 years, 50% of patients were male and 15% had a transapical approach. Procedural success was 88% in the radiation group versus 100% in controls (p<0.001) and 30-day survival was 92% in both groups. Five-year survival was 33%±10% in the radiation group and 42%±11% in controls (p=0.26). In radiation patients, the main cause of death was respiratory insufficiency in 40%. We identified four independent predictive factors of death in the radiation group: extracardiac arteriopathy (p=0.002) and the absence of β-blocker therapy (p=0.005) as preprocedural variables, and infectious complications (p=0.009) and a higher peak creatinine level (p=0.009) as postprocedural variables. In the radiation group, 89% of survivors were in New York Heart Association class I–II at last follow-up.

Conclusions Patients in the radiation group displayed high mortality rates although not significantly different from the controls. Respiratory failure was the main cause of death, emphasising the need for a careful pulmonary evaluation. Finally, we show a sustained improvement in functional results after TAVI in this population.

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