Clinical Outcomes After Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis: Survival and Quality of Life Assessment Michail Papafaklis, Sofia Adali, Spuridon Sioros, Dimitrios Nikas, Socratis Sismanidis, Michail Peroulis, Sotirios Mitsiadis, Christos Katsouras, John Goudevenos, Lampros Michalis University Hospital of Ioannina
Transcatheter Aortic Valve Implantation Transcatheter aortic valve implantation (TAVI) has recently become the standard of care for patients with severe symptomatic aortic stenosis who are considered unsuitable for surgery Limited data are available regarding clinical outcomes following TAVI in Greece AHA website
Study Objectives Report the early experience on patients undergoing TAVI at the University Hospital of Ioannina To investigate the clinical outcomes following TAVI In-hospital outcomes Short and Medium-term survival Changes in clinical symptoms Quality of Life assessment before and after TAVI
Patient Population 25 patients with symptomatic severe aortic valve stenosis underwent TAVI at the University Hospital of Ioannina from February 2013 to March 2016 Age, yrs 79.1±6.6 Male Gender 64% BMI 25.65 Hypertension 92% Diabetes Mellitus 54% COPD 41% Chronic Kidney Disease 56% Creatinine Clearance 57±27 ml/min Previous MI 68% LV Ejection Fraction 49.8±14.8% EuroSCORE 21.1±8.2%
Patient Population: Frailty BASELINE (pre-tavi) Mildly to Severely Frail Canadian Study on Health & Aging, 2008
In-hospital Outcomes: Peri-procedural Complications Permanent Pacing 40% Tamponade 10% Cardiogenic Shock 0% Device Embolization 0% Myocardial Infarction 0% Stroke/TIA 0% New-onset AF 12%
In-hospital Outcomes: Peri-procedural Complications Acute Kidney Injury 23% 15% 62% Stage 1 Stage 2 Stage 3
Clinical Follow-up There were no in-hospital deaths after TAVI Post-discharge clinical follow-up was completed in 22 patients (88%) Mean follow-up duration was 14±10.8 months
Short- & Mid-term Survival SURVIVAL 30 days: 100% 6 months: 85% 1 year: 73% Kaplan-Meier Plot
Clinical Symptoms: Dyspnea NYHA Class P=0.45 I-II III-IV
Clinical Symptoms: Angina CCS P=0.21 I-II III-IV
Quality of Life Assessment: Mobility EuroQoL 5D-5L: Mobility P=0.003 1-2 3-5 EuroQoL Group 2009
Quality of Life Assessment: Self-care EuroQoL 5D-5L: Self-care P=0.090 1-2 3-5 EuroQoL Group 2009
Quality of Life Assessment: Usual Activities EuroQoL 5D-5L: Usual Activities (e.g. work, study, housework, family or leisure activities) P=0.12 1-2 3-5 EuroQoL Group 2009
Quality of Life Assessment: Pain/Discomfort EuroQoL 5D-5L: Pain/Discomfort P=0.011 1-2 3-5 EuroQoL Group 2009
Visual Analog 0-100 Scale x 100 P=0.005 x 75 68 50 44 25 0 Pre-TAVI Post-TAVI EuroQoL Group EuroQoL 2009 Group 2009
Conclusions Patients who underwent TAVI for symptomatic severe stenosis in our hospital Have favorable survival rate Have survival rate similar to that in large studies/trials Experience an improvement in symptoms and quality of life Patients who underwent TAVI demonstrated an overall clinical benefit
Acknowledgments 2 nd Department of Cardiology, University Hospital of Ioannina Lampros K. Michalis Christos S. Katsouras Katerina K. Naka Eleni Sourla Konstantinos Pappas Anna Kotsia Lampros Lakkas Aris Mpechlioulis Sotirios Mitsiadis Georgios Nakas Dimitrios Venetis Theodora Mpampali Maria Midalkou 1 st Department of Cardiology, University Hospital of Ioannina John Goudevenos Dimitrios Nikas Spuros Pappas Panagiotis Korantzopoulos Kirstin Achenbach Marios Kolios Konstantinos Tsimos Xenofontas Makos Vasilis Arguris Catheter Laboratory, University Hospital of Ioannina Nurses and Technologists Michail I. Papafaklis, MD, PhD, FESC m.papafaklis@yahoo.com