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One-year experience of transcatheter aortic valve implantation in elderly patients: South East London TAVI group
  1. The SE London TAVI Group
  1. London, UK

Abstract

Introduction Aortic valve replacement is the only effective treatment for aortic stenosis. Transcatheter aortic valve implantation (TAVI) is an innovative approach for high-risk elderly patients.

Methods 80 patients (mean age 84 ± 7 years) with severe aortic stenosis underwent TAVI with the Edwards Lifesciences Sapien bioprosthesis using a transapical (n  =  48; 60%) or transfemoral (n  =  32; 40%) approach from August 2007. The mean ejection fraction was 50 ± 11%, with maximum peak gradient 84 ± 24 mm Hg, mean peak gradient 52 ± 15 mm Hg and a mean aortic valve orifice area of 0.57 ± 0.15 cm2. The transapical approach was used in patients with peripheral vessel disease and poor vascular access. All patients had high risk for conventional surgery as evidenced by logistic Euroscore (21.6 ± 11.6%) or the presence of a porcelain aorta (n  =  16). 65% of all patients were in NYHA class III or IV.

Results All TAVI were performed in the catheter laboratory under general anaesthesia (n  =  79) or thoracic epidural anaesthesia (n  =  1). The valves were sized based on aortic valve annulus: 23 mm (n  =  37) or 26 mm (n  =  43). Procedural success was achieved in 99% (one patient required conversion from transfemoral to transapical). Only one (1.2%) patient had aortic regurgitation of grade II or greater and two (2.5%) patients required emergency cardiopulmonary bypass. Postprocedural mean and peak gradients were 5.1 ± 4 mm Hg and 9.8 ± 6 mm Hg, respectively. Postoperative complications included stroke (2.5%), complete arteriovenous block (2.5%), renal failure (10%) and major vascular complications (8%). The overall 30-day mortality was 10% (n  =  8). At the time of analysis with a median follow-up of 19.5 weeks (range 1–64 weeks) 64 patients (80%) were alive.

Conclusion TAVI is a feasible treatment option for severe aortic stenosis for high-risk surgical patients, with excellent short-term results and very promising medium-term results.

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