482 Rapid Fire – TAVI: outcomes and future perspectives
Table 1. Events at 1 year
Events at 1 year Systolic PAP
<40 mm Hg 40 to 59 mm Hg >59 mm Hg
(n=845) (n=1112) (n=478)
Death from any cause, n (%) 120 (21.6) 188 (27.8) 92 (28.4)
Death from cardiovascular cause, n (%) 74 (11.1) 112 (13.2) 58 (11)
Myocardial infarction (STEMI and
NSTEMI), n (%) 12 (1.4) 14 (1.3) 5 (1.05)
Major stroke, n (%) 23 (2.7) 22 (2) 12 (2.5)
Mortality from any cause and from cardiovascular cause was calculated on Kaplan-Meier survival
analysis. Deaths from unknown causes were assumed to be deaths from cardiovascular causes.
Conclusion: PH (sPAP > 40 mmHg) in AS patients undergoing TAVI was associ-
ated with increased 1-year mortality especially when severe (sPAP > 60 mmHg)
but not with increased 30-day mortality, and functional status was significantly
improved.
2583 | BEDSIDE
Transcatheter aortic valve implantation for patients with elliptical
aortic annulus
K. Hayashida, E. Bouvier, T. Lefevre, B. Chevalier, T. Hovasse, P. Garot,
Y. Watanabe, M. Romano, B. Cormier, M.C. Morice. Institut Cardiovasculaire
Paris Sud – Hôpital Privé Jacques Cartier, Générale de Santé, Massy, France
Purpose: The purpose of this study was to elucidate impact of annulus ellipticity
on clinical outcomes after transcatheter aortic valve implantation (TAVI).
Methods: Of 548 patients included in our TAVI database with either of the Ed-
wards or CoreValve (October 2006 to June 2012), 305 consecutive patients
undergoing pre-procedural multidetector computed tomography (MDCT) were
analyzed. Ellipticity was defined as "long/short-axis MDCT-measured diameter
ratio>1.20". We compared clinical outcomes in patients with (n = 155) vs. without
(n = 150) ellipticity.
Results: Patients were 83.2±6.6 years old and EuroSCORE was 19.9±12.0%.
The ellipticity group was similar to the non-ellipticity group except for coronary
disease (49.0 vs. 64.0%, P = 0.01). Despite no significant difference in mean
MDCT-measured diameter (23.7±2.1 vs. 23.8±2.1mm, P = 0.47), ellipticity was
associated with decreased short-axis (21.3±2.0 vs. 22.5±2.0mm, P <0.01) and
increased long-axis diameter (27.0±2.5 vs. 25.7±2.5mm, P <0.01) resulting in
increased long/short-axis diameter ratio (1.27±0.07 vs. 1.14±0.06mm, P <0.01).
Ellipticity group tended to have increased incidence of bicuspid valve (12.3% vs.
6.0%, P = 0.06). The CoreValve was used similarly (21.3% vs. 22.0%, P = 0.88).
There was no significant difference in device success (94.2% vs. 93.3%, P =
0.76), risk of annulus rupture (1.3% vs. 0.7%, P = 0.51) or valve migration (0 vs.
2.0%, P = 0.12) between 2 groups. Post-procedural mean gradient (10.1±6.1 vs.
9.7±3.7mmHg, P = 0.52), aortic regurgitation ≥2/4 (15.5% vs 17.3%, P = 0.66),
30-day mortality (5.8% vs. 10.0%, P = 0.17) and 30-day combined safety point
(14.2% vs. 14.7%, P = 0.91) were also similar in both groups.
Conclusions: In patients with ellipticity, TAVI is associated with equally high rates
of success, low complication rates, similar efficacy and acceptable outcomes as
in non-ellipticity patients.
2584 | BEDSIDE
Impact of paravalvular leak following transcatheter aortic valve
replacement on one-year mortality: analysis of the combined
PARTNER cohorts
S. Kodali 1 , R. Hahn 1 , M. Williams 1 , V. Thourani 2 , E.M. Tuzcu 3 , L. Svensson 3 ,
P. Douglas 4 , M. Alu 1 , T. Mcandrew 5 , M. Leon 6 . 1 Columbia University Medical
Center, New York, United States of America; 2 Emory University School of
Medicine, Atlanta, United States of America; 3 Cleveland Clinic Foundation,
Cleveland, United States of America; 4 Duke University Medical Center, Duke
Clinical Research Institute, Durham, United States of America; 5 Cardiovascular
Research Foundation, New York, United States of America; 6 Columbia University
Medical Center and the Cardiovascular Research Foundation, New York, United
States of America
Purpose: To examine severity of paravalvular leak (PVL) and association with 1yr
mortality and other outcomes after transcatheter aortic valve replacement (TAVR)
with the Edwards Sapien valve in the combined PARTNER cohorts.
Methods: 2553 patients underwent TAVR in the randomized or non-randomized
cohorts of the PARTNER trial. Discharge or 7-day echos were available for core
lab analysis in 2270 patients. PVL was graded using semi-quantitative criteria as
none/trace, mild, moderate or severe. Patients were followed for ≥ 1yr; clinical
events were CEC adjudicated. The impact of PVL on mortality was evaluated
using a cox proportional hazards model.
Results: PVL was graded as none/trace in 53.1%, mild in 38.1% and mod/sev
in 8.8%. There were no differences in mean STS risk score between groups,
but in mod/sev and mild (vs none/trace) there were more males, larger BSA,
and more pre-treatment renal disease. 30-day/in-hospital mortality (3.4% vs
3.9% vs 5.5%, p=0.33) and stroke (3.2% vs 3.7% vs 2.5%, p=0.64) were sim-
ilar in all groups (none/trace, mild, mod/sev). At one year, there was increased
all-cause mortality (14.1% vs 22.1% vs 34.1%, p<0.0001), cardiac mortality
(5.1% vs 7.4% vs 18.2%, p<0.0001) and rehospitalization (12.5% vs 22.2% vs
P value
0.032
0.71
0.84
0.54
Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/2583/2861261 by guest on 09 December 2019
Figure 1
30.7%, p<0.0001) with worsening PVL (figure). Multivariate analysis indicated
that the presence of mod/sev (HR 3.58 [2.42, 5.29], p<0.0001) or mild PVL (HR
1.75 [1.28, 2.39], p<0.001) was associated with higher late mortality. All clinical
outcomes, echocardiographic results, and results stratified by approach (trans-
femoral or transapical) will be presented.
Conclusions: Following TAVR, even mild PVL is associated with increased one-
year all-cause and cardiac mortality. Refinements to reduce PVL following TAVR
may improve clinical outcomes in the future.
2585 | BEDSIDE
Safety and feasibilty of transfemoral aortic valve implantation
(CoreValve) in local anesthesia
W. Bocksch, P. Htun, S. Werner, K. Mueller, M. Steeg, I. Mueller, B. Sutaj,
R. Jorbenadze, M. Gawaz, S. Fateh-Moghadam. Medizinische Klinik III, Klinik für
Kardiologie und Kreislauferkrankungen, Eberhard-Karls-Universitä, Tübingen,
Germany
Background: After its introduction, transfemoral aortic valve implantation (TAVI)
was mostly performed under general anesthesia (GA) or in deep sedation (DS).
Due to the increased experience of the technique, device improvement, reduction
of the size of the femoral delivery sheaths and the use of percutaneous arte-
rial closure system, one could imagine that it is feasible to perform TAVI in local
anesthesia (LA).
Aim of the study: The aim of this study was to investigate the safety and feasibilty
of TAVI in LA without deep sedation and without anesthesiological standby.
Methods: From April 2010 until November 2012 in 247 pts underwent trans-
femoral TAVI in LA at our hospital using the CoreValve system (26/29/31mm).
There was no anesthesiological assistance present, but a cardiology fellow with
experience in intensive care. For LA 20 ml of 1% lidocaine was injected sc into
the groin. The CoreValve prothesis was inserted retrogradely via an 18 F sheath.
Before introducing the 18-F-sheath, 2-7,5mg of Piritramid was given iv for anal-
gesia. Closure of the arterial access site was done using the ProStar XL 10F-
percutaneous suture device.
Results: At our hospital 247 pts (age 81.2±0.4 years, 129 male) with severe
AS (pmax 74.8±1.4 mmHg, pmean 44.2±0.9 mmHg, ava 0.6±0.01 cm2 , LVEF
51.1±0.7%, logistic Euroscore 24.3±0.8) underwent the TAVI procedure in LA.
Only one pt had to be converted to GA because of the development of a pul-
monary edema due to a intermittent postinterventional aortic insuffiency grade III,
which could be successfully treated by post-dilatation with a 28mm Balloon. Only
4 pts needed conversion to DS using midazolame/Propofol. There were no in-lab
deaths and no in-lab strokes or TIAs. Mean intervention time was 74±3.4 min, the
mean fluoroscopy time 13.3 min and the amount of contrast was 167±5.3 ml. In-
Lab vascular complications occurred in 8 pts (3.2%); 1 vessel closure (VC) of the
arteria femoralis communis (AFC) due to the Prostar system, 4 sheath induced
dissections of the iliac artery treated by stenting, two iliac perforations treated with
covered stents and 1 unremovable Solopath sheath. Two of these 8 pts (Prostar
VC, unremovable sheath) needed surgical repair. Thirty–day all-cause mortality
was 4.9% (n=12;cardiac mortality 41.6%) and long-term all-cause mortality (1-
year) 14.6% (n=36; cardiac mortality 41.7%). There were 2 strokes during 30
days resulting in a stroke rate of 0.8% and 4 TIAs (1.6%).
Conclusion: TAVI in LA represents a feasible and safe option with low (0%) In-
Lab stroke/TIA rate. Acute-, intermediate and longterm-outcome is excellent.
2586 | BEDSIDE
Is post dilatation useful after implantation of the Edwards valve?
Y. Watanabe 1 , K. Hayashida 1 , T. Lefevre 1 , M. Romano 1 , T. Hovasse 1 ,
B. Chevalier 1 , P. Garot 2 , P. Donzeau-Gouge 1 , A. Farge 1 , M.C. Morice 1 . 1 ICPS
- Hopital Prive Jacques Cartier (Générale de Santé), Massy, France; 2 ICPS -
Hôpital Privé Claude Galien (Générale de Santé), Quincy, France
Background: Little data is available about post-dilatation (PD) for the treatment
of significant paravalvular aortic regurgitation (AR) after transcatheter aortic valve
implantation (TAVI) of the Edwards valve.