Transkateter aort kapak implantasyonu yapılan hastaların sonuçları: Tersiyer bir merkezin 2 yıllık deneyimi

Year 2020, Volume: 12 Issue: 1, 103 - 112, 01.03.2020

Emrah Acar , Mehmet Inanir Alev Kılıçgedik Servet Izci , Mehmet Fatih Yılmaz , Turgut Karabağ İbrahim Akın İzgi Cevat Kırma

https://doi.org/10.21601/ortadogutipdergisi.602187

Abstract

Giriş ve Amaç: Bu çalışmada merkezimizde transkateter aortik kapak implantasyonu (TAVİ) uygulanan hastaların erken ve geç dönem klinik ve ekokardiyografik takip sonuçları değerlendirildi.
Hastalar ve Yöntem: 2011-2013 yılları arasında kliniğimizde ciddi aort darlığı (AD) nedeni ile TAVİ uygulanan 48 hastanın erken ve geç dönem sonuçları değerlendirildi. Tüm hastalara transfemoral yaklaşım ile CoreValve biyoprotez kapak yerleştirildi ve hastalar 17,4±15,3 ay takip edildi.
Bulgular: Hastaların (24’ü kadın, ortalama yaş 77,4±8,1) işlem öncesi ortalama aortic kapak alanı (AVA) 0,7±0,2 cm², ortalama aortik kapak gradiyenti (MnG) 55,4±19,8 mmHg, fonksiyonel sınıfı New York Kalp Cemiyeti (NYHA)’ne göre 2,5±0,4 iken, TAVİ işlemini takiben AVA, MnG ve fonksiyonel sınıflamalarında anlamlı düzelme görüldü. İşlem başarısı %87,5 olup, hastalara ortalama 1,5±0,5 kapak implante edildi. 1 hastada kapak implantasyonu sonrası hemodinamiyi bozan ileri paravalvüler AY geliştiği için cerrahi aort kapak replasmanı yapıldı. İşlemde 3 hastada AV tam blok, 2 hastada koroner obstrüksiyona bağlı ventriküler taşikardi; işlem sonrası erken dönemde ise 3 hastada geçici iskemik atak, 2 hastada minör kanama gelişti. 3 hasta işlemde gelişen kalp tamponadı nedeniyle, 1 hasta işlem sonrası 28. gün enfeksiyon ve sepsis nedeniyle, 2 hasta kompleks ventriküler artimiye bağlı kardiyak arrestten, 2 hasta da 1. ve 4. aylarda kalp dışı nedenlerden hayatını kaybetti. İşlemin 3 yıllık yaşam süresi %75 bulundu.
Sonuç: Cerrahi riski yüksek veya opere edilemeyecek olan semptomatik AD hastalarında, cerrahiye alternatif bir tedavi yöntemi olarak klinik pratiğe girmiş olan TAVİ işlemi, erken ve geç dönem sonuçları itibariyle başarılı ve güvenilir bir yöntemdir.

Keywords

aort darlığı, ekokardiyografi, transkateter

Results of patients who underwent transcatheter aortic valve implantation: 2 years experience of a tertiary center

Abstract

Background: The early and late term results of who underwent transcatheter aortic valve implantation (TAVI) in our center were evaluated in this study.
Patients and Methods: The early and late term results of 48 patients with severe aortic stenosis who underwent the TAVI procedure in our clinic between 2011 and 2013 years were evaluated. All of our patients were implanted with CoreValve bioprosthetic valves through the transfemoral approach and followed-up for 17.4±15.3 months.
Results: Before the procedure, the mean aortic valve area (AVA) was 0.7±0.2cm², the mean valvular gradients (MnG) were 55.4±19.8 mmHg and the mean functional class was 2.5±0.4. Following the TAVI procedure the AVA, MnG and functional class were improved, significantly. The technical success rate was %87.5, and mean 1.5±0.5 valves was implanted in all patients. Surgical AVR was required for 1 patient because of severe paravalvular leakage. At the procedure, in 3 patients third degree atrioventricular (AV) block and in 2 patient coronary occlusion were developed. The patients with third degree AV block was required permanent pacemaker. In the early term after TAVI in 3 patients transient ischemic attack and in 2 patients minors hemoragy were developed. 3 patient was dead of cardiac tamponade in the procedure, 1 patient was dead from infections and sepsis postoperative 28th days, 2 patients were dead from cardiac arrest because of complex ventricular arrythmia, 2 patients were dead of noncardiac reasons on the 1st and 4th months, respectively. In this study 3 years survi of TAVI procedure was %75.
Conclusion: In the patients with high surgery risk or inoperable aortic stenosis TAVI is a rather safe and successful method in the early and late terms as an alternative therapy to surgery.

Keywords

aortic stenosis, echocardiography, transcatheter

References

• Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, ve ark. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation. 2002;106(24):3006-8.
• Wendler O, Dworakowski R. TAVI in patients unsuitable for surgery: a prognostic benefit for all? Journal of the American College of Cardiology. 2014;63(9):912-3.
• Yücel G, Akçevin A, Sezer A, Eryılmaz A, Özyiğit T, Sezer T, ve ark. Transkateter aort kapak yerleştirme: Türkiye`deki ilk uygulamalar ve erken sonuçlar Archives of the Turk Society of Cardiology 2010; 38:258-263
• Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A, Griffin BP, ve ark. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2009;22(1):1-23; quiz 101-2.
• Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, ve ark. Guidelines on the management of valvular heart disease (version 2012). European Heart Journal. 2012;33(19):2451-96.
• Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, 3rd, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. The Journal of Thoracic and Cardiovascular Surgery. 2014;148(1):e1-e132.
• Schoenenberger AW, Stortecky S, Neumann S, Moser A, Juni P, Carrel T, ve ark. Predictors of functional decline in elderly patients undergoing transcatheter aortic valve implantation (TAVI). European heart Journal. 2013;34(9):684-92.
• Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, ve ark. Transcatheter aortic-valve replacement with a self-expanding prosthesis. The New England Journal of Medicine. 2014;370(19):1790-8.
• Kappetein AP, Head SJ, Genereux P, Piazza N, van Mieghem NM, Blackstone EH, ve ark. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. European Heart Journal. 2012;33(19):2403-18.
• Webb JG, Pasupati S, Humphries K, Thompson C, Altwegg L, Moss R, et al. Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis. Circulation. 2007;116(7):755-63.
• Biancari F, Rosato S, D’Errigo P, Ranucci M, Onorati F, Barbanti M, ve ark. Immediate and Intermediate Outcome After Transapical Versus Transfemoral Transcatheter Aortic Valve Replacement. The American Journal of Cardiology. 2016;117(2):245-51.
• Panchal HB, Barry N, Bhatheja S, Albalbissi K, Mukherjee D, Paul T. Mortality and major adverse cardiovascular events after transcatheter aortic valve replacement using Edwards valve versus CoreValve: A meta-analysis. Cardiovascular Revascularization Medicine: Including Molecular Interventions. 2015.
• Nombela-Franco L, Ruel M, Radhakrishnan S, Webb JG, Hansen M, Labinaz M, ve ark. Comparison of hemodynamic performance of self-expandable CoreValve versus balloon-expandable Edwards SAPIEN aortic valves inserted by catheter for aortic stenosis. The American Journal of Cardiology. 2013;111(7):1026-33.
• Aksu T, Yuksel UC, Tuzcu M. Percutaneous treatment of aortic stenosis. Archives of the Turk Society of Cardiology 2010;38(4):290-301.
• Boerlage-Van Dijk K, Kooiman KM, Yong ZY, Wiegerinck EM, Damman P, Bouma BJ, ve ark. Predictors and permanency of cardiac conduction disorders and necessity of pacing after transcatheter aortic valve implantation. Pacing and Clinical Electrophysiology: PACE. 2014;37(11):1520-9.
• Mouillet G, Lellouche N, Yamamoto M, Oguri A, Dubois-Rande JL, Van Belle E, ve ark. Outcomes following pacemaker implantation after transcatheter aortic valve implantation with CoreValve((R)) devices: Results from the FRANCE 2 Registry. Catheterization and cardiovascular interventions : official Journal of the Society for Cardiac Angiography & Interventions. 2015;86(3):E158-66.
• Cribier A, Eltchaninoff H, Tron C, Bauer F, Agatiello C, Sebagh L, ve ark. Early experience with percutaneous transcatheter implantation of heart valve prosthesis for the treatment of end-stage inoperable patients with calcific aortic stenosis. Journal of the American College of Cardiology. 2004;43(4):698-703.
• Durand E, Eltchaninoff H, Canville A, Bouhzam N, Godin M, Tron C, ve ark. Feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation with the Edwards SAPIEN-XT prosthesis. The American Journal of Cardiology. 2015;115(8):1116-22.
• Haussig S, Linke A. Patient selection for TAVI 2015 - TAVI in low-risk patients: fact or fiction? EuroIntervention: Journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2015;11 Suppl W:W86-91.
• Seiffert M, Conradi L, Baldus S, Schirmer J, Blankenberg S, Reichenspurner H, ve ark. Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach. European Journal of Cardiothoracic Surgery. 2013;44(3):478-84; discussion 84.
• Van Mieghem NM, Tchetche D, Chieffo A, Dumonteil N, Messika-Zeitoun D, van der Boon RM, ve ark. Incidence, predictors, and implications of access site complications with transfemoral transcatheter aortic valve implantation. The American Journal of Cardiology. 2012;110(9):1361-7.
• van der Boon RM, Nuis RJ, Benitez LM, Van Mieghem NM, Perez S, Cruz L, ve ark. Frequency, determinants and prognostic implications of infectious complications after transcatheter aortic valve implantation. The American Journal of Cardiology. 2013;112(1):104-10.
• Ussia GP, Barbanti M, Petronio AS, Tarantini G, Ettori F, Colombo A, ve ark. Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis. European Heart Journal. 2012;33(8):969-76.