Denuded iliac endothelium with long-term high-cholesterol-diet-induced vascular dysfunction and accelerated atherosclerosis as well as neointimal formations after BMS implantation

Abstract

Background: TAVI is by now a valid therapeutic option in elderly patients (pts) with severe symptomatic aortic stenosis considered at high risk or with contraindication to aortic valve replacement (AVR). The impact of postprocedural leaks on mortality is still debated. Methods: Since May 2008 to July 2011, 100 consecutive pts underwent TAVI (60 Edwards Sapien Valve, 40 CoreValve). Transthoracic echocardiogram (TTE) was performed before discharge and after 3 months. Prosthesis insufficiency (PI) was considered significant if at least mild according to ASE and EAE recommendations. The aim of the study is to evaluate the effect of postprocedural periprosthetic and intraprosthetic leaks on mortality. Results: Retrograde approach was performed in 67 pts, while 33 pts benefited from the transapical access. Predischarge TTE was performed in all pts, and 24 had at least mild PI: 17 (70.8%) periprosthetic, 3 (12.5%) intraprosthetic, and 4 (16.7%) mixed. VARC mortality was 15%. At 3-month follow-up (range 36–126 days), all 85 alive pts underwent a TTE at our institution. Significant leaks were found in 24 (28.2%) pts: 18 (75%) periprosthetic, 1 (4.2%) intraprosthetic, and 5 (20.4%) mixed. The univariate analysis with Yatescorrected χ showed that postprocedural PI affects 1-year mortality (RR 2.68, IC 1.39–5.18, P=.009). Subgroups analysis showed an increased incidence of leaks in CoreValve group compared to the Edwards Sapien group (28/36 vs. 24/49, P=.02). Conclusion: Periprosthesis leaks, affected also by prosthesis choice, increase 1-year mortality in patients undergoing TAVI. These data confirm the actual limits of this procedure compared to AVR. In the near future, new technologies and devices could help to improve results.