ROTATIONAL ATHERECTOMY IN UNCROSSABLE AND UNDILATABLE LESIONS: OUTCOMES POST SECOND-GENERATION DRUG ELUTING STENTS

Abstract

BACKGROUND: Short and long term result of Trans-catheter aortic valve implantation (TAVI) for extreme high risk patients are not well known. We investigate difference of success rate, major complications and short and long term mortality after TAVI between extreme high risk and the other risk. METHODS: From 185 patients who undertook TAVI using balloon or self -expanding valve between 2009 and 2014 were included in the study. Extreme high risk was defined as STS score was 10.0 or higher. Major complication was defined as death, stroke, myocardial infarction, unplanned open chest surgery and percutaneous circulation support insertion. Whole sample was divided into 2 groups: extreme high risk and standard risk group. All patients were observed at least 6 months. Success, major complication, and 1month and 12 month mortality rate was compared. RESULTS: 60 and 125 patients were included in extreme high risk and standard group. Mean STS score was 14.8 in extreme high risk and 5.9 in standard group. Compared to standard group, extreme high risk group was significantly older (p <0.001). Extreme high risk group had smaller height (p 1⁄4 0.003), smaller annulus (p 1⁄4 0.004), higher creatinine (p 1⁄4 0.001) and lower KATZ ADL score (p 1⁄4 0.046). Female and stroke was more likely included in extreme high risk group (p <0.001 and p 1⁄4 0.026, respectively). No difference was observed in the other patient backgrounds. Regarding procedural contents, no significant difference was observed between 2 groups except for selfexpanding valve was more likely used (p 1⁄4 0.002). Extreme high risk group showed significantly lower success rate compared to standard group (90.0% in extreme high risk vs 98.4% in standard group, p 1⁄4 0.015). There was no statistical difference between 2 groups in major complication rate (10.0% in extreme high risk and 6.4% in standard group, p 1⁄4 0.39). Although mortality in extreme high risk group was higher than standard group, the difference did not reach statistical difference (1 month mortality rate in extreme high risk group: 3.3% and in standard group: 1.6%, p 1⁄4 0.60) and (12 month mortality rate: 8.3% in extreme high risk group and 4.0% in standard group, p 1⁄4 0.18). CONCLUSION: Except for success rate, no statistical difference was observed between extreme high and standard risk patients in short and long term outcomes after TAVI. TAVI for extreme high risk patients was effective and as safe as standard risk patients.