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Transcatheter Aortic Valve Implantation: Risk Assessment and Clinical Outcome

Johansson, Malin LU (2015) In Lund University, faculty of Medicine Doctoral Dissertation Series 2015:37.
Abstract
Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a treatment for patients with aortic stenosis (AS) and high surgical risk. To date, reports of short- and mid-term survival have been favourable. The aim of this thesis was to evaluate early safety, risk assessment and late survival following TAVI.

Methods: In this work we studied clinical outcome, prediction of 30-day mortality and acute kidney injury and late renal dysfunction following TAVI. In paper I and IV, a comparisons to propensity score matched patients undergoing AVR were made.

Results: The 30-day mortality following TAVI and AVR was 4.2% and 4.8% respectively (p=0.81); however, significant differences were seen in... (More)
Abstract

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a treatment for patients with aortic stenosis (AS) and high surgical risk. To date, reports of short- and mid-term survival have been favourable. The aim of this thesis was to evaluate early safety, risk assessment and late survival following TAVI.

Methods: In this work we studied clinical outcome, prediction of 30-day mortality and acute kidney injury and late renal dysfunction following TAVI. In paper I and IV, a comparisons to propensity score matched patients undergoing AVR were made.

Results: The 30-day mortality following TAVI and AVR was 4.2% and 4.8% respectively (p=0.81); however, significant differences were seen in corresponding rates of survival (51.7±5.8% vs 72.3±4.3%; p<0.001) and in cumulative re-hospitalizations for congestive heart failure (CHF) (41.3±7.2% vs 23±4.3%; p=0.006) over a 4-year period. Postoperative AKI was diagnosed in 33% following TAVI and renal function remained impaired at 1 year of follow-up. The observed/expected mortality ratio was 0.16 for logistic EuroSCORE, 0.56 for STS score, and 0.52 for EuroSCORE II. The AUC was 0.69 (95% CI 0.54–0.84) for the logistic EuroSCORE, 0.60 (95% CI 0.38–0.82) for the STS score, and 0.66 (95% CI 0.46–0.86) for the EuroSCORE II.

Conclusions: The results of this thesis confirm the merit of TAVI in high risk patients with AS, although late outcome with TAVI proved inferior to that of AVR in propensity score matched patients. In our view, the relationship between TAVI and AVR appears to be complementary rather than substitutive. Furthermore, more accurate risk assessment tools are needed. (Less)
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author
supervisor
opponent
  • Professor Thelin, Stefan, Thoracic Surgery, Uppsala University
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Key words: Aortic stenosis, transcatheter aortic valve implantation, outcome, acute kidney injury
in
Lund University, faculty of Medicine Doctoral Dissertation Series
volume
2015:37
pages
86 pages
publisher
Department of Cardiothoracic Surgery, Clinical Sciences, Lund University
defense location
Segerfalksalen, BMC, Lund.
defense date
2015-04-29 09:00
ISSN
1652-8220
ISBN
978-91-7619-116-3
language
English
LU publication?
yes
id
c7217287-eba7-4d25-b2cb-74344d3b1d2c (old id 5385886)
date added to LUP
2015-05-18 13:56:18
date last changed
2016-09-19 08:44:50
@phdthesis{c7217287-eba7-4d25-b2cb-74344d3b1d2c,
  abstract     = {Abstract <br/><br>
Background: Transcatheter aortic valve implantation (TAVI) has emerged as a treatment for patients with aortic stenosis (AS) and high surgical risk. To date, reports of short- and mid-term survival have been favourable. The aim of this thesis was to evaluate early safety, risk assessment and late survival following TAVI. <br/><br>
Methods: In this work we studied clinical outcome, prediction of 30-day mortality and acute kidney injury and late renal dysfunction following TAVI. In paper I and IV, a comparisons to propensity score matched patients undergoing AVR were made.<br/><br>
Results: The 30-day mortality following TAVI and AVR was 4.2% and 4.8% respectively (p=0.81); however, significant differences were seen in corresponding rates of survival (51.7±5.8% vs 72.3±4.3%; p&lt;0.001) and in cumulative re-hospitalizations for congestive heart failure (CHF) (41.3±7.2% vs 23±4.3%; p=0.006) over a 4-year period. Postoperative AKI was diagnosed in 33% following TAVI and renal function remained impaired at 1 year of follow-up. The observed/expected mortality ratio was 0.16 for logistic EuroSCORE, 0.56 for STS score, and 0.52 for EuroSCORE II. The AUC was 0.69 (95% CI 0.54–0.84) for the logistic EuroSCORE, 0.60 (95% CI 0.38–0.82) for the STS score, and 0.66 (95% CI 0.46–0.86) for the EuroSCORE II. <br/><br>
Conclusions: The results of this thesis confirm the merit of TAVI in high risk patients with AS, although late outcome with TAVI proved inferior to that of AVR in propensity score matched patients. In our view, the relationship between TAVI and AVR appears to be complementary rather than substitutive. Furthermore, more accurate risk assessment tools are needed.},
  author       = {Johansson, Malin},
  isbn         = {978-91-7619-116-3},
  issn         = {1652-8220},
  keyword      = {Key words: Aortic stenosis,transcatheter aortic valve implantation,outcome,acute kidney injury},
  language     = {eng},
  pages        = {86},
  publisher    = {Department of Cardiothoracic Surgery, Clinical Sciences, Lund University},
  school       = {Lund University},
  series       = {Lund University, faculty of Medicine Doctoral Dissertation Series},
  title        = {Transcatheter Aortic Valve Implantation: Risk Assessment and Clinical Outcome},
  volume       = {2015:37},
  year         = {2015},
}