.: ORİJİNAL ARAŞTIRMA
Comparison of Balloon-Expandable and Self-Expandable Valves in Patients with Transcatater Aortic Valve Implantation in Terms of Demographic and Complications and Evaluation of the Predictors of Complications: A Retrospective Single Center Experience
Transkatater Aort Kapak İmplantasyonu Olan Hastalarda Balonla Genişleyebilir ve Kendinden Genişleyebilir Kapakların Demografik ve Komplikasyonlar Açısından Karşılaştırılması ve Komplikasyonların ÖngördürücülerininDeğerlendirilmesi: Retrospektif Tek Merkez Deneyimi
Turkiye Klinikleri J Cardiovasc Sci. 2023;35(1):13-20
doi: 10.5336/cardiosci.2023-96212
Makale Dili: EN
Tam Metin
ABSTRACT
Objective: Transcatheter aortic valve implantation (TAVI) offers an alternative to surgery for patients with symptomatic severe aortic stenosis. Currently, the most commonly used valves for clinical use are the Balloon-expandable Edwards SAPIEN and Self-expandable CoreValve Revalving valves. The aim of our study is to compare these valve types used in TAVI procedures performed in our center and to determine the predictors of complications. Material and Methods: 96 patients who underwent TAVI in our center were included in our study. Pre-procedural clinical, laboratory and echocardiographic data of patients who underwent TAVI were reviewed retrospectively. Results: Complications developed in 31 (32.3%) of the patients. Total complications were found to be higher in patients with balloon-expandable valve (18 vs. 13, p=0.036, respectively). In patients who developed complications, hemoglobin and hematocrit values at the time of admission to the hospital were found to be significantly lower, and C-reactive protein was found to be high. Among the echocardiographic findings at admission, the aortic valve area was found to be narrower and the maximum and mean gradient was higher in patients with complications. Conclusion: In our study, a lower complication rate was observed in self-expandable valves. Some independent markers of TAVI-specific complications and mortality were identified. Examination of new predictors and development of a TAVI-specific scoring system may be considered in future prospective controlled studies.
Keywords: Aortic valve diseases; aortic valve stenosis; transcatheter aortic valve replacement; postoperative complications
Objective: Transcatheter aortic valve implantation (TAVI) offers an alternative to surgery for patients with symptomatic severe aortic stenosis. Currently, the most commonly used valves for clinical use are the Balloon-expandable Edwards SAPIEN and Self-expandable CoreValve Revalving valves. The aim of our study is to compare these valve types used in TAVI procedures performed in our center and to determine the predictors of complications. Material and Methods: 96 patients who underwent TAVI in our center were included in our study. Pre-procedural clinical, laboratory and echocardiographic data of patients who underwent TAVI were reviewed retrospectively. Results: Complications developed in 31 (32.3%) of the patients. Total complications were found to be higher in patients with balloon-expandable valve (18 vs. 13, p=0.036, respectively). In patients who developed complications, hemoglobin and hematocrit values at the time of admission to the hospital were found to be significantly lower, and C-reactive protein was found to be high. Among the echocardiographic findings at admission, the aortic valve area was found to be narrower and the maximum and mean gradient was higher in patients with complications. Conclusion: In our study, a lower complication rate was observed in self-expandable valves. Some independent markers of TAVI-specific complications and mortality were identified. Examination of new predictors and development of a TAVI-specific scoring system may be considered in future prospective controlled studies.
Keywords: Aortic valve diseases; aortic valve stenosis; transcatheter aortic valve replacement; postoperative complications
ÖZET
Amaç: Transkateter aort kapak implantasyonu [transcatheter aortic valve implantation (TAVI)], semptomatik ciddi aort darlığı olan hastalarda cerrahiye bir alternatif sunar. Şu anda klinik kullanım için en yaygın kullanılan valfler, Balonla genişletilebilir Edwards SAPIEN ve Kendiliğinden genişletilebilir CoreValve Revalving valfleridir. Çalışmamızın amacı, merkezimizde uygulanan TAVI işlemlerinde kullanılan bu kapak tiplerini karşılaştırmak ve komplikasyonların öngörücülerini belirlemektir. Gereç ve Yöntemler: Çalışmamıza, merkezimizde TAVI uygulanan 96 hasta dâhil edildi. TAVI uygulanan hastaların işlem öncesi klinik, laboratuvar ve ekokardiyografik verileri retrospektif olarak incelendi. Bulgular: Hastaların 31'inde (%32,3) komplikasyon gelişti. Balonla genişleyebilir kapaklı hastalarda toplam komplikasyon daha yüksek bulundu (sırasıyla 18'e karşı 13, p=0,036). Komplikasyon gelişen hastalarda hastaneye başvuru anındaki hemoglobin ve hematokrit değerleri anlamlı olarak düşük, C-reaktif protein ise yüksek bulundu. Başvuru anındaki ekokardiyografik bulgular arasında komplikasyon gelişen hastalarda aort kapak alanı daha dar, maksimum ve ortalama gradiyent daha yüksek bulundu. Sonuç: Çalışmamızda kendiliğinden genişleyen kapaklarda daha düşük komplikasyon oranı gözlendi. TAVI'ya özgü komplikasyonların ve mortalitenin bazı bağımsız belirteçleri belirlendi. Gelecekteki prospektif kontrollü çalışmalarda, yeni öngörücülerin incelenmesi ve TAVI'ya özgü bir skorlama sisteminin geliştirilmesi düşünülebilir.
Anahtar Kelimeler: Aort kapak hastalığı; aort kapak stenozu; transkateter aort kapağının değiştirilmesi; postoperatif komplikasyonlar
Amaç: Transkateter aort kapak implantasyonu [transcatheter aortic valve implantation (TAVI)], semptomatik ciddi aort darlığı olan hastalarda cerrahiye bir alternatif sunar. Şu anda klinik kullanım için en yaygın kullanılan valfler, Balonla genişletilebilir Edwards SAPIEN ve Kendiliğinden genişletilebilir CoreValve Revalving valfleridir. Çalışmamızın amacı, merkezimizde uygulanan TAVI işlemlerinde kullanılan bu kapak tiplerini karşılaştırmak ve komplikasyonların öngörücülerini belirlemektir. Gereç ve Yöntemler: Çalışmamıza, merkezimizde TAVI uygulanan 96 hasta dâhil edildi. TAVI uygulanan hastaların işlem öncesi klinik, laboratuvar ve ekokardiyografik verileri retrospektif olarak incelendi. Bulgular: Hastaların 31'inde (%32,3) komplikasyon gelişti. Balonla genişleyebilir kapaklı hastalarda toplam komplikasyon daha yüksek bulundu (sırasıyla 18'e karşı 13, p=0,036). Komplikasyon gelişen hastalarda hastaneye başvuru anındaki hemoglobin ve hematokrit değerleri anlamlı olarak düşük, C-reaktif protein ise yüksek bulundu. Başvuru anındaki ekokardiyografik bulgular arasında komplikasyon gelişen hastalarda aort kapak alanı daha dar, maksimum ve ortalama gradiyent daha yüksek bulundu. Sonuç: Çalışmamızda kendiliğinden genişleyen kapaklarda daha düşük komplikasyon oranı gözlendi. TAVI'ya özgü komplikasyonların ve mortalitenin bazı bağımsız belirteçleri belirlendi. Gelecekteki prospektif kontrollü çalışmalarda, yeni öngörücülerin incelenmesi ve TAVI'ya özgü bir skorlama sisteminin geliştirilmesi düşünülebilir.
Anahtar Kelimeler: Aort kapak hastalığı; aort kapak stenozu; transkateter aort kapağının değiştirilmesi; postoperatif komplikasyonlar
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