Patients with aortic stenosis referred for TAVI: Treatment decision, in-hospital outcome and determinants of survival

R. J. Nuis, A. E. Dager, R. M. Van der Boon, M. C. Jaimes, B. Caicedo, J. Fonseca, N. M. Van Mieghem, L. M. Benitez, J. P. Umana, W. W. O'Neill, Eduardo De Marchena, P. P. de Jaegere

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Aims To assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI. Methods Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium. Results Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and medical therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient preference (29%), peripheral vascular disease (15%) and non-severe aortic stenosis (11%). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10%, p=0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24% after TAVI and 8 and 25% after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, p<0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95% CI: 1.05-1.33), pre-existing renal failure (HR: 1.18; 95% CI: 1.06-1.33) and STS score (HR: 1.06; 95% CI: 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR: 3-23) months after TAVI. Conclusions Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.

Original languageEnglish
Pages (from-to)16-23
Number of pages8
JournalNetherlands Heart Journal
Volume20
Issue number1
DOIs
StatePublished - Feb 1 2012
Externally publishedYes

Fingerprint

Aortic Valve Stenosis
Survival
Aortic Valve
Therapeutics
Mortality
Transcatheter Aortic Valve Replacement
Peripheral Vascular Diseases
Patient Preference
Group Psychotherapy
Surgical Instruments
Blood Transfusion
Observational Studies
Renal Insufficiency
Prospective Studies
Safety

Keywords

  • Aortic stenosis
  • Complications
  • Prognosis
  • Surgical aortic valve replacement
  • Transcatheter aortic valve implantation
  • Treatment decision

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Nuis, R. J., Dager, A. E., Van der Boon, R. M., Jaimes, M. C., Caicedo, B., Fonseca, J., ... de Jaegere, P. P. (2012). Patients with aortic stenosis referred for TAVI: Treatment decision, in-hospital outcome and determinants of survival. Netherlands Heart Journal, 20(1), 16-23. https://doi.org/10.1007/s12471-011-0224-z

Patients with aortic stenosis referred for TAVI : Treatment decision, in-hospital outcome and determinants of survival. / Nuis, R. J.; Dager, A. E.; Van der Boon, R. M.; Jaimes, M. C.; Caicedo, B.; Fonseca, J.; Van Mieghem, N. M.; Benitez, L. M.; Umana, J. P.; O'Neill, W. W.; De Marchena, Eduardo; de Jaegere, P. P.

In: Netherlands Heart Journal, Vol. 20, No. 1, 01.02.2012, p. 16-23.

Research output: Contribution to journalArticle

Nuis, RJ, Dager, AE, Van der Boon, RM, Jaimes, MC, Caicedo, B, Fonseca, J, Van Mieghem, NM, Benitez, LM, Umana, JP, O'Neill, WW, De Marchena, E & de Jaegere, PP 2012, 'Patients with aortic stenosis referred for TAVI: Treatment decision, in-hospital outcome and determinants of survival', Netherlands Heart Journal, vol. 20, no. 1, pp. 16-23. https://doi.org/10.1007/s12471-011-0224-z
Nuis, R. J. ; Dager, A. E. ; Van der Boon, R. M. ; Jaimes, M. C. ; Caicedo, B. ; Fonseca, J. ; Van Mieghem, N. M. ; Benitez, L. M. ; Umana, J. P. ; O'Neill, W. W. ; De Marchena, Eduardo ; de Jaegere, P. P. / Patients with aortic stenosis referred for TAVI : Treatment decision, in-hospital outcome and determinants of survival. In: Netherlands Heart Journal. 2012 ; Vol. 20, No. 1. pp. 16-23.
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abstract = "Aims To assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI. Methods Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium. Results Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65{\%}), surgical aortic valve replacement (AVR) in 24 (7{\%}) and medical therapy (MT) in 99 (28{\%}). Reasons to decline TAVI in favour of AVR/MT were patient preference (29{\%}), peripheral vascular disease (15{\%}) and non-severe aortic stenosis (11{\%}). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10{\%}, p=0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24{\%} after TAVI and 8 and 25{\%} after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12{\%} vs. 22{\%}, 21{\%} vs. 33{\%} and 31{\%} vs. 55{\%}, respectively, p<0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95{\%} CI: 1.05-1.33), pre-existing renal failure (HR: 1.18; 95{\%} CI: 1.06-1.33) and STS score (HR: 1.06; 95{\%} CI: 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR: 3-23) months after TAVI. Conclusions Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7{\%} underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.",
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AU - Van der Boon, R. M.

AU - Jaimes, M. C.

AU - Caicedo, B.

AU - Fonseca, J.

AU - Van Mieghem, N. M.

AU - Benitez, L. M.

AU - Umana, J. P.

AU - O'Neill, W. W.

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N2 - Aims To assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI. Methods Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium. Results Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and medical therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient preference (29%), peripheral vascular disease (15%) and non-severe aortic stenosis (11%). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10%, p=0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24% after TAVI and 8 and 25% after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, p<0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95% CI: 1.05-1.33), pre-existing renal failure (HR: 1.18; 95% CI: 1.06-1.33) and STS score (HR: 1.06; 95% CI: 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR: 3-23) months after TAVI. Conclusions Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.

AB - Aims To assess treatment decision and outcome in patients referred for transcatheter aortic valve implantation (TAVI) in addition to predictive factors of mortality after TAVI. Methods Three-centre prospective observational study including 358 patients. Endpoints were defined according to the Valve Academic Research Consortium. Results Of the 358 patients referred for TAVI, TAVI was performed in 235 patients (65%), surgical aortic valve replacement (AVR) in 24 (7%) and medical therapy (MT) in 99 (28%). Reasons to decline TAVI in favour of AVR/MT were patient preference (29%), peripheral vascular disease (15%) and non-severe aortic stenosis (11%). The logistic EuroSCORE was significantly higher in patients who underwent TAVI and MT in comparison with those undergoing AVR (19 vs. 10%, p=0.007). At 30 days, all-cause mortality and the combined safety endpoint were 9 and 24% after TAVI and 8 and 25% after AVR, respectively. All-cause mortality was significantly lower in the TAVI group compared with the MT group at 6 months, 1 year and 2 years (12% vs. 22%, 21% vs. 33% and 31% vs. 55%, respectively, p<0.001). Multivariable analysis revealed that blood transfusion (HR: 1.19; 95% CI: 1.05-1.33), pre-existing renal failure (HR: 1.18; 95% CI: 1.06-1.33) and STS score (HR: 1.06; 95% CI: 1.02-1.10) were independent predictors of mortality at a median of 10 (IQR: 3-23) months after TAVI. Conclusions Approximately two-thirds of the patients referred for TAVI receive this treatment with gratifying short- and long-term survival. Another 7% underwent AVR. Prognosis is poor in patients who do not receive valve replacement therapy.

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