The Athens TAVR Registry of newer generation transfemoral aortic valves: 30-day outcomes

Konstantinos Spargias, Konstantinos Toutouzas, Michael Chrissoheris, Andreas Synetos, Antonis Halapas, Ioannis Paizis, Georgios Latsios, Konstantinos Stathogiannis, Konstantinos Stathogianni, Spyridon Papametzelopoulos, Stavros Zanos, Gregory Pavlides, Achileas Zacharoulis, Aias Antoniades, Christodoulos Stefanadis
Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē 2013, 54 (1): 18-24

INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is a documented treatment for patients with symptomatic aortic stenosis who are at very high or prohibitive operative risk. We sought to investigate the outcomes of transfemoral procedures with the newer generation valves in four TAVR centres in Athens, Greece.

METHODS: The ATHENS TAVR Registry included all patients who underwent transfemoral implantation of the newer generation valves in 4 Athens TAVR centres (self-expanding valve 67 patients, balloon-expandable valve 59 patients). We present the procedural and echocardiographic data and the 30-day clinical outcomes according to valve type.

RESULTS: A total of 126 patients underwent 126 procedures (67 CoreValve, Medtronic; 59 SAPIEN XT, Edwards Lifesciences). The mean age and logistic EuroSCORE were 80 ± 8 years and 25 ± 13%. The procedural and device success rates were 100% and 98%, respectively. The 30-day mortality was 1% (n=1), the major vascular event rates 9% (similar for both valve types), and a new permanent pacemaker was implanted more often during the same hospitalisation after CoreValve (33% vs. 9%, p=0.001). The mean effective aortic valve area increased and the mean transvalvular pressure gradient declined post implantation (from 0.66 ± 0.15 cm(2) to 1.61 ± 0.43 cm(2), p<0.001; from 51 ± 14 mm Hg to 10 ± 3 mm Hg, p<0.001). The mean grade of aortic insufficiency increased after CoreValve (from 1.2 ± 0.6 to 1.5 ± 0.7, p=0.03) but remained stable after SAPIEN XT (1.0 ± 0.8 and 1.0 ± 0.6, p=0.88) implantation.

CONCLUSIONS: TAVR outcomes with both the newer generation transfemoral valves in the ATHENS Registry were excellent. We observed a greater need for a new permanent pacemaker and a greater degree of aortic valve insufficiency after CoreValve implantation.

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