G. Viart

Trends over the past 4 years in population characteristics, 30-day outcomes and 1-year survival in patients treated with transcatheter aortic valve implantation

BACKGROUND Transcatheter aortic valve implantation (TAVI) is recommended in patients with severe aortic stenosis that is either inoperable or at high-risk for surgical valve replacement. AIMS To evaluate trends in the feasibility and safety of transfemoral TAVI over the past 4 years. METHODS Between 2010 and 2013, all consecutive patients undergoing TAVI in our institution were included in a prospective registry. Population characteristics and 30-day and 1-year outcomes were analysed. Outcomes were classified according to the Valve Academic Research Consortium-2. RESULTS Overall, 429 patients underwent TAVI; transfemoral access was used in 368 (85.7%). The proportion of patients treated via a transfemoral approach increased (70.1% to 89.9%; P<0.0001) and the use of prior balloon aortic valvuloplasty decreased (44.7% to 11.2%; P<0.0001). The mean logistic EuroSCORE decreased significantly from 19.4±10.9% to 15.8±8.7% (P=0.01). The 30-day mortality rate did not change significantly (6.4% vs. 5.6%; P=0.99). Similarly, rates of major vascular complications (12.8% vs. 15.4%; P=0.87) and stroke (2.1% vs. 1.4%; P=0.75) remained unchanged. Mean length of stay after TAVI decreased significantly from 8.9±11.3 days to 4.8±4.7 days (P=0.002) and 72 (50.3%) patients were discharged early in 2013. One-year survival increased significantly from 81.0% to 94.4% (P=0.03). CONCLUSIONS Over the past 4 years, TAVI has been increasingly performed using a transfemoral approach. Treated patients are at lower-risk with less co-morbidity. Thirty-day mortality and complications remained unchanged, but length of stay after TAVI and 1-year mortality decreased dramatically.

Pacemaker memory in post-TAVI patients: Who should benefit from permanent pacemaker implantation?

One of the most frequent complications of transcatheter aortic valve implantation (TAVI) is the occurrence of atrioventricular (AV) conduction disorders secondary to AV node or His bundle injury leading to permanent pacemaker implantation (PPI). The objective was to quantify the rate of ventricular pacing (VP), according to post‐TAVI indication for PPI using recorded pacemaker memory.

A STEP FORWARD IN THE MINIMALIST STRATEGY FOR TRANSFEMORAL TRANSCATHETER AORTIC VALVE IMPLANTATION WITH THE EDWARDS SAPIEN-XT PROSTHESIS: FEASIBILITY AND SAFETY OF EARLY DISCHARGE

There is currently no consensus on the duration of hospitalization required after TAVI. We report the feasibility and safety of early discharge after transfemoral transcatheter aortic valve implantation (TAVI) with the Edwards SAPIEN-XT prosthesis. Between 2009 and 2013, 337 patients underwent

0299 : Use of clinical follow-up and pacemaker memories to define predictors of complete atrio-ventricular block or sudden death after balloon- expandable transcatheter aortic valve implantation

Backgrounds Predictors of atrio-ventricular block (AVB) after transcatheter aortic valve implantation (TAVI) have been described as those leading to syncope or permanent pacemaker implantation (PPI), and thus have been assimilated to criterias used by the investigators for pacemaker implantation. Aims Evaluating the true predictors of AVB following TAVI, using clinical follow-up and devices’ memories. Methods Between 2011 and 2013, 213 patients without previous PPI underwent TAVI with an Edwards SAPIEN XT balloon-expandable valve using a femoral approach, in our institution. All patients had continuous cardiac rhythm monitoring ≥24 hours after TAVI. ECG was performed the following 2 days after TAVI, and 1 month later. Median follow-up for pacemaker interrogation was 8 months. Results Complete AVB occurred in 22 patients (10.3%), sudden death in 8 patients (3.8%). Pacemaker was implanted in 26 patients (12.2%). For 20 of them (77%), pacemaker memories showed complete AVB episodes or ≥2% ventricular pacing, despite the use of a minimizing ventricular pacing algorithm. Results of the multivariate analysis are shown below. Table No complete AVB or Sudden death (%) Complete AVB or Sudden death (%) Odds Ratio (95% CI) P Preexisting RBBB 15 (8) 13 (43) 6.62 (1.7 - 26.3) 0.007 New persistant LBBB 14 (8) 8 (33) 10.1 (2.5 – 41.7) 0.001 1st degree AVB after TAVI 34 (27) 9 (56) 3.48 (1.1 – 11.2) 0.04 LBBB: left bundle branch block; RBBB: right bundle branch block Conclusions Our findings confirmed pre-existing RBBB and new persistent LBBB as predictors of AVB following TAVI. We also demonstrated here for the first time, first degree AVB is an independent predictive factor of severe conduction disorders after TAVI.

0219 : Outcomes of patients undergoing femoral covered stent graft during percutaneous transcatheter aortic valve implantation

Although vascular complications are frequent after percutaneous transcatheter aortic valve implantation (TAVI), they can be managed percutaneously most of the time by implanting a covered stent graft in the femoral artery. Aims To evaluate the characteristics of patients who required femoral stent implantation after TAVI and to determine the long-term impact of stent placement in the femoral position. Methods Between January 2011 and December 2013, 320 patients underwent transfemoral TAVI in our center using the Edwards Sapien XT valve. After gaining vascular access, a pre-closure technique was performed with a 10-F ProStar XL closure device followed by16 to 20-F sheath insertion for 23, 26 or 29mm valve implantation. After valve implantation and sheath removal, access site was closed with the ProStar device. An ilio-femoral angiography was performed via the contralateral femoral artery to assess final result and a self-expandable covered stent graft was placed at the level of vessel injury in case of persistent bleeding despite prolonged manual compression or balloon occlusion. Follow-up was performed by phone call and duplex ultrasonography of the access site. Results 29 (9%) patients required emergency femoral covered stent graft implantation. Patients characteristics were comparable to those of patients who did not require stent implantation except for previous anticoagulant therapy which was significantly associated with stent implantation (44.8% vs 27.1%, p = 0.045). Despite stent implantation, 2 patients underwent surgery for persistent bleeding. Stent implantation did not affect survival (p=0.456). At a median follow-up of 23 months, only 1 patient complained of groin discomfort impacting his daily life. Neither stent fracture nor occlusion was noted by ultrasonography. Conclusion Vascular complications after TAVI can be safely treated percutaneously by femoral covered stent graft with minimal long-term functional impairment and no impact on survival.