How has the qualification of patients for transcatheter aortic valve implantation changed over the last 5 years in a single, high-volume center in Poland?

Introduction

Among single native valve heart diseases (VHD), aortic stenosis (AS) is now the most prevalent valve defect in adults (33.9%) [1]. Early detection and management of AS is of paramount importance, because untreated disease is universally fatal [2]. There is no evidence that any pharmacotherapy truly increases life expectancy; therefore the only effective method of treatment is valve replacement (surgical or transcatheter). The first transcatheter aortic valve implantation (TAVI) was performed in 2002 by Cribier, and since then it has become an established and increasingly used method of treatment [3].

Aim

We decided to compare characteristics of patients qualified for TAVI in the years 2014–2016 and 2017–2019.

Material and methods

We retrospectively analyzed 210 consecutive patients with severe degenerative AS, who were assigned to TAVI at the National Institute of Cardiology in the period 2014–2019. Two groups of patients were distinguished and compared: 1) patients who underwent TAVI between 2014 and 2016, and 2) in whom TAVI was performed between 2017 and 2019. Severe aortic stenosis was defined according to the 2017 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery Guidelines as the mean transvalvular gradient > 40 mm Hg and effective orifice area (AVA) < 1 cm2 [4]. Transcatheter heart valve size and approach were selected by using multidetector computed tomography angiography. The following data were collected: age, sex, comorbidities: the presence of the coronary artery disease, history of myocardial infarction, percutaneous coronary interventions in the past, coronary artery bypass grafting, previous stroke, hypertension, chronic kidney disease, diabetes, chronic obstructive pulmonary disease, laboratory tests results (complete blood count, creatinine, transaminase, glucose and cholesterol levels) and echocardiographic parameters (transvalvular mean and maximal gradient, AVA, ejection fraction, right ventricular systolic pressure and occurrence of other valve diseases). European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) was used to estimate the risk of death after surgery. Three risk groups of 30-day mortality were identified: a low-risk (EuroSCORE II ≤ 4%), an intermediate-risk (EuroSCORE II between 4% and 8%) and a high-risk group (EuroSCORE II > 8%). The final decision to refer for TAVI was made by the Heart Team. The protocol of the...


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