Direct transcatheter aortic valve implantation - one-year outcome of a case control study

作者：Kochman Janusz; Koltowski Lukasz^*; Huczek Zenon; Scislo Piotr; Bakon Leopold; Wilimski Radoslaw; Rymuza Bartosz; Opolski Grzegorz

来源：Postepy w Kardiologii Interwencyjnej, 2014, 10(4): 250-257.

DOI：10.5114/pwki.2014.46766

• transaortic valve implantation
• pre-dilatation
• no pre-dilatation
• aortic valve
• balloon valvuloplasty

Introduction: Transaortic valve implantation (TAVI) has a well-established position in the treatment of high-risk and inoperable patients with severe aortic stenosis (AS). The TAVI protocol requires a pre-dilatation for native valve preparation. %26lt;br%26gt;Aim: To assess the safety and feasibility of TAVI without pre-dilatation and to compare it with the procedure with pre-dilatation. %26lt;br%26gt;Material and methods: Out of 101 TAVI patients, in 10 the procedure was performed without balloon predilatation, and 8 patients were included in the analysis. The procedural, echocardiographic, and clinical outcomes were compared with a case control matched cohort (1: 2 ratio). A 12-month follow-up was done in all cases. %26lt;br%26gt;Results: The procedure was successfully completed in all patients in the study group (SG), but there was one procedural failure in the control group (CG). All patients received a Core Valve (Medtronic) bioprosthesis. There was a significant immediate decrease in transvalvular gradients (TG) in both study arms after the procedure (SG: mean TG: from 46.0 +/- 14.0 mm Hg to 10.0 +/- 4.8 mm Hg, p %26lt; 0.001; CG: mean TG: from 55.9 +/- 12.0 mm Hg to 9.9 +/- 2.9 mm Hg, p %26lt; 0.001). A marked increase in the effective orifice areas was observed in both cohorts (SG: 1.63 +/- 0.13 cm(2) and CG: 1.67 +/- 0.25 cm(2), p = 0.75). The periprocedural complication rate was equally distributed in both arms. The 12-month all-cause mortality was 12.5% in both groups. %26lt;br%26gt;Conclusions: The direct TAVI approach seams to be safe and feasible. The clinical and echocardiographic results are not different from those achieved in patients treated with standard TAVI protocol with pre-dilatation.

• 出版日期2014-12