Transcatheter aortic valve implantation in patients younger than 75 years: Guidelines-based patients selection and clinical outcome

Chiara Fraccaro, Luca Testa, Alessandro Schiavo, Nedy Brambilla, Massimo Napodano, Danila Azzolina, Francesco Bedogni, Giuseppe Tarantini

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Patients treated by transcatheter aortic valve implantation (TAVI) in all major recent trials are still mostly octogenarians. Aim of this study is to analyze the risk profile and outcome of TAVI patients <75 years. Methods and results: We retrospectively analyzed 172 patients <75 years with symptomatic severe native AS or degeneration of surgical aortic bioprosthesis treated with TAVI. The level of surgical risk was reassessed according to multiparametric ACC classification (prohibitive in 68 patients, high in 34, intermediate in 70). Mean age was 69.02 ± 6.18 years, mean STS score 5.56 ± 5.21. The majority of them presented one or more clinical or anatomical characteristics favoring TAVI according to ECS guidelines, despite the young age. Vascular access was transfemoral in 76%. According to the VARC-2 definitions, device success was high (90%) in all groups. The early safety was 89%, clinical recovery was slower in prohibitive risk patients. Bleeding events were more frequent in prohibitive and high surgical risk classes. Clinical efficacy at 1 year was overall 83%, and significantly better in intermediate risk patients (p = 0.004). The functional status remained stable over time as well as prostheses performance. Conclusion: About 40% of patients <75 years were treated by TAVI due to the presence of a prohibitive risk, mainly related to technical impediments. The remaining was referred to TAVI due to an estimated high or intermediate surgical risk driven by STS score, frailty and/or major organ system compromise. Early and mid-term clinical and hemodynamic outcomes were good, in particular in intermediate risk patients.

Original languageEnglish
Pages (from-to)273-278
Number of pages6
JournalInternational Journal of Cardiology
Volume272
DOIs
Publication statusPublished - Dec 1 2018

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Patient Selection
Guidelines
Bioprosthesis
Transcatheter Aortic Valve Replacement
Prostheses and Implants
Blood Vessels
Hemodynamics
Hemorrhage
Safety
Equipment and Supplies

Keywords

  • Aortic stenosis
  • Surgical risk
  • Transcatheter aortic valve implantation
  • Young age

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Transcatheter aortic valve implantation in patients younger than 75 years : Guidelines-based patients selection and clinical outcome. / Fraccaro, Chiara; Testa, Luca; Schiavo, Alessandro; Brambilla, Nedy; Napodano, Massimo; Azzolina, Danila; Bedogni, Francesco; Tarantini, Giuseppe.

In: International Journal of Cardiology, Vol. 272, 01.12.2018, p. 273-278.

Research output: Contribution to journalArticle

Fraccaro, Chiara ; Testa, Luca ; Schiavo, Alessandro ; Brambilla, Nedy ; Napodano, Massimo ; Azzolina, Danila ; Bedogni, Francesco ; Tarantini, Giuseppe. / Transcatheter aortic valve implantation in patients younger than 75 years : Guidelines-based patients selection and clinical outcome. In: International Journal of Cardiology. 2018 ; Vol. 272. pp. 273-278.
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abstract = "Background: Patients treated by transcatheter aortic valve implantation (TAVI) in all major recent trials are still mostly octogenarians. Aim of this study is to analyze the risk profile and outcome of TAVI patients <75 years. Methods and results: We retrospectively analyzed 172 patients <75 years with symptomatic severe native AS or degeneration of surgical aortic bioprosthesis treated with TAVI. The level of surgical risk was reassessed according to multiparametric ACC classification (prohibitive in 68 patients, high in 34, intermediate in 70). Mean age was 69.02 ± 6.18 years, mean STS score 5.56 ± 5.21. The majority of them presented one or more clinical or anatomical characteristics favoring TAVI according to ECS guidelines, despite the young age. Vascular access was transfemoral in 76{\%}. According to the VARC-2 definitions, device success was high (90{\%}) in all groups. The early safety was 89{\%}, clinical recovery was slower in prohibitive risk patients. Bleeding events were more frequent in prohibitive and high surgical risk classes. Clinical efficacy at 1 year was overall 83{\%}, and significantly better in intermediate risk patients (p = 0.004). The functional status remained stable over time as well as prostheses performance. Conclusion: About 40{\%} of patients <75 years were treated by TAVI due to the presence of a prohibitive risk, mainly related to technical impediments. The remaining was referred to TAVI due to an estimated high or intermediate surgical risk driven by STS score, frailty and/or major organ system compromise. Early and mid-term clinical and hemodynamic outcomes were good, in particular in intermediate risk patients.",
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AU - Fraccaro, Chiara

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AU - Brambilla, Nedy

AU - Napodano, Massimo

AU - Azzolina, Danila

AU - Bedogni, Francesco

AU - Tarantini, Giuseppe

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