TORNA ALL’ELENCO

TCT-675 Futility in Transcatheter Aortic Valve Implantation: result from the Italian Multicenter OBSERVANT Study in Journal of the American College of Cardiology

2016
AOU Città della Salute di Torino

Tipo pubblicazione

Conference Abstract

Autori/Collaboratori (9)Vedi tutti...

Salizzoni S

D'Errigo P

Barbero C


et alii...

Abstract

Background: Transcatheter Aortic Valve Implantation (TAVI) is a valid treatment in high-risk patients with severe aortic valve stenosis. Recent trials demonstrated similar short-term outcomes compared to surgery also in low-risk patients. To date, there is no agreement regarding the profile of patient in whom TAVI is likely to be beneficial, especially in compromised and so called “inoperable” patients. Objective of the study is to identify those patients who do not benefit from TAVI, regardless by the excellent periprocedural-result (and we defined as “futile” procedure). Methods: All patients that underwent TAVI between December 2010 and June 2012 and were enrolled in the OBservational Study of Effectiveness of AVR-TAVI procedures for severe Aortic steNosis Treatment (OBSERVANT) were included in the analysis. Futility was defined as 1-year mortality in patients survived at 30 days. Multivariable analysis was performed to assess pre-operative independent predictors of futility. Results: A total of 1911 patients that underwent TAVI were enrolled in the OBSERVANT. Only the data from 1728 patients that survive 30 days after TAVI were analyzed. One-year mortality was 13.5% (233 patients). The independent pre-operative predictors of futility, corrected for major post-procedural complications, were: male gender (HR 1.38; 95% CI 1.00-1.90); serum creatinine (every 1 mg/dL increase of HR 1.18; 95% CI 1.03-1.35); frailty score (grade 1: HR 1.94; 95% CI 1.34-2.79; grade 2:HR 1.72; 95% CI 1.17-2.52; grade 3:HR 6.28; 95% CI 3.54-11.14); previous procedures on the aorta (HR 1.89; 95% CI 1.15-3.09); percutaneous transluminal coronary angioplasty (PTCA) at the time of TAVI (HR 1.98; 95% CI 1.07-3.63). Conclusion: Male gender, kidney dysfunction, low- and mid-grade of frailty, previous procedures on the aorta and PTCA concomitant with TAVI are independent predictors of one-year mortality in patients undergoing successful TAVI. In these subgroups a proper and careful

DOI : 10.1016/j.jacc.2016.09.088

Keywords

observational study; multicenter study; mortality; male; major clinical study; kidney dysfunction; human tissue; human; gender; frailty; female; dementia; creatinine blood level; controlled study; conference abstract; complication; aortic stenosis; adult; patient selection; preoperative evaluation; transcatheter aortic valve implantation; transluminal coronary angioplasty; valvular heart disease;