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Valvular Heart Disease Summit: Experience Impacts Outcomes
Key Points:
• Feasibility studies in U.S. and Europe indicate percutaneous approaches improve with more operator experience.
By TCT Daily Staff
Early studies of transcatheter aortic valve replacement have demonstrated that the technique is becoming safer and more effective as clinicians learn from initial experiences, according to data from three trials predominantly using the Edwards Sapien THV.
John Webb, MD, of St. Paul’s Hospital, Vancouver, Canada, presented findings on 172 patients from the Vancouver TAVR study. In those who underwent transarterial replacement (n=114), procedural success grew from 81.6% in the first tertile to 97.4% in both the second and third tertiles of patients treated.
Similarly, 30-day mortality rates were 13.2% in the first tertile, dropping to 10.5% in the second and 0% in the third tertile.
Procedural success was higher in transapical procedures (n=58): 96.6% for the first half treated and 100% for the latter half. In the same population, 30-day mortality dropped from 24.1% to 13.8% over time.
Webb noted a "steep learning curve" in understanding valve positioning and femoral access, major sources of morbidity, and mortality early in the series.
European TRAVERSE
The TRAVERSE feasibility study, presented by Thomas Walther, MD, of the University of Leipzig, Germany, assessed the European experience with transapical aortic valve replacement from December 2004 to April 2008 (see Table).
The main perioperative complications were apical bleeding (4.8%), hemodynamic instability (4.8%), and coronary occlusion/impingement (3.6%). At 30-day follow-up, the most common complications were new pacemaker (5.9%), cardiac failure (5.4%), and temporary renal failure requiring hemofiltration (10.1%).
Walther said that TAVR was a "clear success story. It’s a minimally invasive off-pump and very safe procedure right now," with excellent steerability and low stroke risk. Through the learning experience of TRAVERSE, researchers have improved results, particularly by employing a team approach that involves cardiac surgeons, cardiologists, and anesthesiologists, he said.
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