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 language | English |
|---|---|
| Pages (from-to) | 273-278 |
| Number of pages | 6 |
| Journal | International Journal of Cardiology |
| Volume | 272 |
| DOIs | |
| Publication status | Published - Dec 1 2018 |
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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 journal › Article
}
TY - JOUR
T1 - Transcatheter aortic valve implantation in patients younger than 75 years
T2 - Guidelines-based patients selection and clinical outcome
AU - Fraccaro, Chiara
AU - Testa, Luca
AU - Schiavo, Alessandro
AU - Brambilla, Nedy
AU - Napodano, Massimo
AU - Azzolina, Danila
AU - Bedogni, Francesco
AU - Tarantini, Giuseppe
PY - 2018/12/1
Y1 - 2018/12/1
N2 - 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.
AB - 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.
KW - Aortic stenosis
KW - Surgical risk
KW - Transcatheter aortic valve implantation
KW - Young age
UR - http://www.scopus.com/inward/record.url?scp=85051406998&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85051406998&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2018.08.021
DO - 10.1016/j.ijcard.2018.08.021
M3 - Article
C2 - 30104032
AN - SCOPUS:85051406998
VL - 272
SP - 273
EP - 278
JO - International Journal of Cardiology
JF - International Journal of Cardiology
SN - 0167-5273
ER -