The Journal of Thoracic and Cardiovascular Surgery
Adult: Aortic ValveOutcomes of procedural complications in transfemoral transcatheter aortic valve replacement
Graphical abstract
Section snippets
Patient Selection
All patients undergoing TAVR at our institution between November 2011 and June 2018 were reviewed. Patients with alternate access TAVR, other than transfemoral, and those with concomitant percutaneous mitral intervention were excluded. This research was approved by our institutional review board with waived patient consent (protocol #2010P000292, initial approval February 11, 2010).
Data Sources and Variables of Interest
Patient demographic characteristics, laboratory values, operative details, and in-hospital outcomes were obtained
Study Population and Perioperative Outcomes
Overall, 866 patients were included in the final analysis. The mean age was 80 ± 9.5 and 458 patients (52.9%) were women (Table 1). The mean STS PROM in this group was 4.8% ± 2.7%, and 128 (14.8%) patients had a pacemaker in place before TAVR. The median preprocedural ejection fraction was 60% (IQR, 55%-65%). The majority of patients had primary pathology of aortic stenosis (80.1%). The mean preoperative aortic valve gradient was 43 ± 9.5 mm Hg and the mean aortic valve area was 0.7 ± 0.2 cm2.
Discussion
Our 5-year study of 866 patients undergoing transfemoral TAVR between 2011 and 2018 had several important findings (Figure 6). First, PVL was the most common complication studied (23%), followed by LBBB (15%), PPM (8%), and stroke (4%). Second, severe stroke was the only complication associated with a survival penalty over the 5-year follow-up period, and severe stroke was independently associated with reduced mid-term survival. Third, although greater-than-mild PVL was associated with
Conclusions
This real-world, longitudinal study of TAVR complications provides important information regarding midterm significance of stroke, PVL, LBBB, and PPM. Severe stroke following TAVR is associated with poor longitudinal survival. Additionally, initial mortality risks associated with greater-than-mild PVL may be attenuated over time. Our findings highlight the importance of complication prevention in the application of TAVR to patients with long life expectancy.
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Supported by departmental funds and the University of British Columbia Clinician Investigator Program (Dr Percy).