Author + information
- Khaled Al-Shaibi,
- Waqar Ahmed,
- Mirvat Alasnag,
- Yousef Nosir,
- Rayyan Kateb and
- Abdulaziz Al-Shaibi
The Partner 2 Trial results made the case for extending the indications for TAVR into the intermediate risk group with a mean STS score of 5.8. Here, we present our results of TAVR in a low risk group with mean STS score of 2.9 and mean follow up of 2 years.
This is a prospective cohort study of 46 consecutive patients from our institution who underwent TAVR between 2012 and 2016. All patients were referred to our center with severe symptomatic AS. They underwent a comprehensive assessment by the heart team. Age, functional status, coronary disease, co-morbid conditions were assessed. Imaging parameters included ejection fraction (EF), aortic valve morphology, gradient, annulus, and concomitant valvular disease. Patients who were deemed poor surgical candidates by the heart team were referred for TAVR. Immediate procedural success, mean gradient and paravalvular leak (PVL) were measured. Patients were followed clinically and echocardiographically with a range of 1-4 years.
46 patients were included in this study, 28 men and 17 women with a mean age of 75 years. Twelve had coronary artery disease (5 prior PCI and 5 prior CABG). The mean EF was 56%, mean MG of 51 mmHg and mean PG of 87 mmHg. All valves were trileaflet aortic valves. None had significant coexistent valvular pathology. The mean STS score was 2.9. Forty-two underwent a transfemoral and 4 a transaortic TAVR. Twenty five received the Sapien XT valve while 21 were treated with a Sapien 3 valve (thirty three 23 mm, twelve 26 mm, and one 29 mm valve). All 46 valves were implanted successfully. There was no valve embolization, annular rupture or need for a second valve. One patient had moderate PVL. Postprocdeure mean MG was 11 mmHg. There was one procedure related stroke. Three patients required a permanent pacemaker. 30-Day mortality was 2 out of 46 (4.3%). Follow up ranged from 1-4 years with a mean of 25.5 months. The mean MG at 2 years was 12 mmHg. Those with any degree of PVL, no increase was noted. Those with trace and mild PVL tended to resolve. Late mortality occurred in 5 patients all non-cardiac.
TAVR in this low risk group of patients was successful with excellent valve performance and no late cardiac mortality. This data supports a randomized trial to determine the validity of TAVR in low risk individuals. Although the STS score clearly identifies intermediate and high risk patients suitable for TAVR, it does not take into account the overall frailty and limited mobility of many elderly patients placing them at a higher surgical risk despite their low STS scores.