Clinical outcomes of transcatheter aortic valve implantation in patients younger than 70 years rejected for surgery: the AMTRAC registry
Por:
Witberg G., Landes U., Codner P., Barbanti M., Valvo R., De Backer O., Ooms J.F., McInerney A., Masiero G., Werner P., Armario X., Fiorina C., Arzamendi D., Santos-Martinez S., Baz J.A., Steblovnik K., Mauri V., Adam M., Merdler I., Hein M., Ruile P., Russo M., Musumeci F., Sedaghat A., Sugiura A., Grasso C., Branca L., Estévez-Loureiro R., Amat-Santos I.J., Mylotte D., Andreas M., Bunc M., Tarantini G., Nombela-Franco L., Sondergaard L., Van Mieghem N.M., Finkelstein A., Kornowski R.
Publicada:
1 ene 2022
Resumen:
Background: The mean age of transcatheter aortic valve implantation (TAVI) patients is steadily decreasing. Aims: The aim of the study was to describe the characteristics, the indications for and the outcomes of TAVI in patients <70 years old. Methods: All patients undergoing TAVI (n=8,626) from the 18 participating centres between January 2007 and June 2020 were stratified by age (70). For patients <70, the indications for TAVI were extracted from Heart Team discussions and the baseline characteristics and mortality were compared between the two groups. Results: Overall, 640 (7.4%) patients were <70 (9.1% during 2018-2020, p<0.001); the mean age was 65.0±2.3 years. The younger patients were more often male, with bicuspid valves or needing valve-in-valve procedures. They had a higher prevalence of lung disease and diabetes. In 80.7% of cases, the Heart Team estimated an increased surgical risk and TAVI was selected, reflected by an STS score >4% in 20.4%. Five-year mortality was similar (29.4 vs 29.8%, HR 0.95, p=0.432) in the <70 and >70 groups. In the <70 group, mortality was higher for those referred for TAVI due to an increased surgical risk compared to those referred for other reasons (31.6 vs 24.5%, HR 1.23, p=0.021). Mortality was similar regardless of the STS stratum in patients judged by the Heart Team to be at increased surgical risk (32.6 vs 30.4%, HR 0.98, p=0.715). Conclusions: Use of TAVI in patients <70 is becoming more frequent. The main reason for choosing TAVI is due to an increased surgical risk not adequately represented by the STS score. The outcomes for these patients are similar to those for older TAVI patients. Dedicated trials of TAVI/SAVR in younger patients are needed to guide decisions concerning expansion of TAVI indications. © Europa Digital & Publishing 2022. All rights reserved.
Filiaciones:
Witberg G.:
Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Landes U.:
Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Codner P.:
Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Barbanti M.:
Division of Cardiology, University of Catania, Catania, Italy
Valvo R.:
Division of Cardiology, University of Catania, Catania, Italy
De Backer O.:
Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Ooms J.F.:
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
McInerney A.:
Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
Masiero G.:
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
Werner P.:
Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
Armario X.:
Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
Fiorina C.:
Cardiovascular Department, Spedali Civili, Brescia, Italy
Arzamendi D.:
Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
Santos-Martinez S.:
CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Baz J.A.:
Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
Steblovnik K.:
Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
Mauri V.:
Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
Adam M.:
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Merdler I.:
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Hein M.:
Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Ruile P.:
Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
Russo M.:
San Camillo Forlanini Hospital, Rome, Italy
Musumeci F.:
San Camillo Forlanini Hospital, Rome, Italy
Sedaghat A.:
Herzzentrum Bonn Universitätsklinikum Bonn, Bonn, Germany
Sugiura A.:
Herzzentrum Bonn Universitätsklinikum Bonn, Bonn, Germany
Grasso C.:
Division of Cardiology, University of Catania, Catania, Italy
Branca L.:
Cardiovascular Department, Spedali Civili, Brescia, Italy
Estévez-Loureiro R.:
Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
Amat-Santos I.J.:
CIBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
Mylotte D.:
Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland
Andreas M.:
Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
Bunc M.:
Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
Tarantini G.:
Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
Nombela-Franco L.:
Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
Sondergaard L.:
Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
Van Mieghem N.M.:
Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, Netherlands
Finkelstein A.:
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Kornowski R.:
Division of Cardiology, Rabin Medical Centre, Petah-Tikva, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Open Access
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