RT Journal Article
SR Electronic
T1 Early and late outcomes after trans-catheter aortic valve implantation in patients with previous chest radiation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 1044
OP 1051
DO 10.1136/heartjnl-2015-309101
VO 102
IS 13
A1 Claire Bouleti
A1 Myriam Amsallem
A1 Aziza Touati
A1 Dominique Himbert
A1 Bernard Iung
A1 Benjamin Alos
A1 Eric Brochet
A1 Marina Urena
A1 Walid Ghodbane
A1 Phalla Ou
A1 Marie-Pierre Dilly
A1 Patrick Nataf
A1 Alec Vahanian
YR 2016
UL http://heart.bmj.com/content/102/13/1044.abstract
AB 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.