Verhältnis von Nutzen und Risiko der kathetergestützten Aortenklappenimplantation (TAVI) in verschiedenen Subgruppen einer unizentrischen Kohorte mit chirurgischen Hochrisikopatienten

Verhältnis von Nutzen und Risiko der kathetergestützten Aortenklappenimplantation (TAVI) in verschiedenen Subgruppen einer unizentrischen Kohorte mit chirurgischen Hochrisikopatienten

The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts in a single-centre with high-risk patients

Tanja Viel

Doctoral thesis

Date of Examination: 2017-08-08

Date of issue: 2017-08-08

Advisor: Puls, Miriam PD Dr.

Referee: Schillinger, Wolfgang Prof. Dr.

Referee: Tirilomis, Theodor Prof. Dr.

Referee: Sigler, Matthias Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0023-3EC8-D

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Abstract

English

Background: Transcatheter aortic valve implantation (TAVI) has recently developed into an acceptable alternative to conventional surgery in high-risk patients. However, information on the identification of patients gaining most benefit from this procedure is still limited. The aim of this study was to evaluate safety and efficacy of TAVI in different patient cohorts. Methods: Between August 2008 and December 2010, 180 high-risk patients underwent TAVI at our institution (97 transapical and 83 transfemoral approaches). Periprocedural complications as well as mortality and incidence of MACCE during follow-up were recorded. Results: Mean age was 82 ± 5 years, and mean logistic EuroScore 27 ± 14%. In the total cohort, 30-day mortality was 8.9% and 12-month survival (according to Kaplan-Meier-analysis) 72%, with no significant differences between the two approaches. However, a significant difference in survival was obvious after stratification of patients according to logistic EuroScore mortality estimates. Survival proportions at 1 year were 62% in patients with logistic EuroScore >40%, 71% in patients with EuroScore 20-40% and 80% in octogenarians with EuroScore <20% (P = 0.009). Furthermore, the observed median event-free survival as an indicator for morbidity ranged between 315 days in the first, 442 days in the second and 710 days in the third group (P = 0.1). Conclusions: TAVI proved to be feasible with reproducible results. However, mortality and rehospitalization rates were considerably high in specific patient cohorts, suggesting that the risk-to-benefit ratio of TAVI should be validated individually. In the present study, octogenarians with logistic EuroScore <20% could be identified as candidates apparently gaining high benefit from the procedure.

Keywords: TAVI; high-risk patients; MACCE

Schlagwörter: TAVI; Hochrisikopatienten; MACCE