Degenerative aortic stenosis is the most common valvular heart disease in the elderly, and many patients are not suitable for aortic valve replacement surgery. Transcatheter aortic valve implantation (TAVI) is a new therapeutic option for selected patients at high risk for surgery.
To evaluate the safety and efficacy of TAVI in Australian patients.
A prospective study of patients undergoing TAVI for severe symptomatic aortic stenosis at The Prince Charles Hospital, Brisbane, Australia between August 2008 and July 2013. Patients were at high risk of surgical aortic valve replacement, or inoperable, as deemed by a multidisciplinary 'heart team'. Outcomes include procedural success and complications; 30-day and 1-year mortality and stroke; combined endpoints as outlined by the Valve Academic Research Consortium 2 (VARC-2) consensus document.
209 patients underwent TAVI during the study period. The mean age was 83.7±6.7 years and 101 (48%) were males. The valve systems utilised were: Edwards-SAPIEN valve in 104 (49.5%), Medtronic CoreValve in 86 (41.2%), Boston Scientific Lotus valve in 19 (9.3%) patients. 30-day and 1-year mortality rates were 5.7% and 11.5% respectively. 30-day and 1-year stroke rates were 4.3% and 6.2% respectively. The composite endpoints of device success, early safety and clinical efficacy occurred in 80.4%, 27.3% and 68.4%.
TAVI with various valve systems, delivered via a number of approaches, is feasible in high surgical risk and inoperable patients with severe aortic stenosis, with acceptable outcomes at short- and intermediate-term follow-up.