TAVI FOR VERY SMALL PATIENTS

Abstract

Although Asian patients are much smaller compared to western patients, same devices have been used for trans-catheter aortic valve implantation (TAVI). Outcomes for them are not well known. We compared success, complication and short term mortality rate between very small and the other patients. 185 patients who undertook TAVI using balloon or self-expanding valve between 2009 and 2014 in Sunnybrook Health Science Center, Toronto and St Luke’s International Hospital, Tokyo were included in the study. Whole group was divided into 2 groups: very small and standard group. Very small was defined as height was shorter than 150cm. Major complication was defined as death, stroke, myocardial infarction, unplanned open chest surgery, unplanned percutaneous circulation support system. Minor complication was defined as access site complication, unplanned peripheral intervention/surgery, and pacer implantation. Success, 1 month mortality and major complication rate was compared. 33 and 152 patients were included in very small and standard group. Mean height was 147cm in very small and 167cm in standard group (p <0.001). Body mass index was 23.3 and 26.0 (p <0.001), respectively. Very small group showed significantly older age (p = 0.035), higher STS score (p <0.001), smaller annulus (p <0.001) and smaller LV mass (p <0.001). Female was more frequently included in very small group (p <0.001). No significant difference was observed in the other factors in patient backgrounds. Regarding procedural contents, no significant difference was observed between 2 groups except for non-femoral access was more likely used in very small group (p <0.001). Success rate was 90.9% in very small and 96.7% in standard group (p = 0.15). 1 month mortality rate was 3.0% and 2.0% (p = 0.55), respectively. Major complication rate was 15.2% and 5.9%, respectively (p = 0.14). Minor complication rate was 21.2% and 23.7%, respectively (p = 1.00). Although very small group showed higher risk for TAVI compared to standard group, no significant difference was observed in outcomes. TAVI for very small patients was considered to be as effective and safe as standard patinets.