Two-year Experience with balloon-Expandable Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis at a Tertiary Center

Anıl Şahin; Ahmet Caner Canpolat; Enes Gül; İdris Buğra Çerik; İbrahim Gül

doi:10.7197/cmj.1474981

TR EN

Şiddetli Aort Darlığında Tersiyer Bir Merkezde Yapılan Transkateter Aort Kapak Replasmanının İki Yıllık Sonuçları

Öz

Amaç Aort darlığı (AD), özellikle gelişmiş ülkelerde müdahale gerektiren en yaygın kapak hastalığıdır. Transkateter aort kapak replasmanı (TAVR), yüksek cerrahi risk taşıyan ve işlem sonrası 12 aydan fazla sağkalım beklentisi olan hastalarda endikedir. Yıllar içinde, TAVR yöntemi semptomatik ciddi AD'li hastalar için önemli bir tedavi seçeneği olarak ortaya çıkmış ve ülkemizde de uygulanmaya başlanmıştır. Bu çalışmanın amacı, merkezimizde TAVR geçiren hastaların kısa ve uzun vadeli sonuçlarını değerlendirmek ve TAVR prosedürü ile kurum deneyimimizi değerlendirmektir. Yöntem Bu retrospektif, tek merkezli analiz, Mart 2022 ile Şubat 2024 arasında TAVR geçiren 16 ardışık semptomatik AD'li hastayı içerdi. Çalışmaya dahil edilen tüm hastalar, balon genişletilebilir bir TAVR kapak implantasyonu geçirdi. Çalışmada, hastaların preoperatif ve postoperatif takiplerinde demografik özellikleri, klinik durumları ve ekokardiyografik bulguları değerlendirilip karşılaştırıldı. Bulgular Tüm popülasyonun ortalama yaşı 78.3 ± 8.7 yıl idi ve %50'si kadındı. Hastaların %93.8'inde transfemoral erişim kullanıldı. İmplantasyon başarısı tüm vakalarda sağlandı. TAVI işlemi sırasında hastaların %12.5'ine kalıcı kalp pili implantasyonu gerekti. Tüm kohort için hastanede kalış süresinin ortalama uzunluğu 4.5 ± 2.3 gün idi. Hastane taburculuğundan önce hiçbir hastanede ölüm olmadı. Takip sırasında, 3 hastanın tüm nedenlere bağlı olarak öldüğü görüldü. Çalışmanın ortalama takip süresi 552 gün olup, en uzun takip süresi 666 gündü. Tüm ekokardiyografik parametrelerde ve fonksiyonel kapasitede belirgin bir iyileşme gözlendi. Ek prosedür gerektiren orta veya şiddetli aort yetersizliği vakası bulunmadı. Sonuç Merkezimizdeki TAVR sonuçları, daha geniş çalışmalarla tutarlıdır. Bazı prosedürle ilgili komplikasyonlara rağmen, cihaz ve tekniklerdeki ilerlemelerin bunları azaltması ve prosedür deneyimi arttıkça sonuçların geliştirilmesi beklenmektedir. Tıbbın daha az invaziv yaklaşımları tercih etmesiyle, TAVR'in farklı hasta grupları arasında cerrahiye alternatif olarak daha yaygın bir seçenek haline gelmesi beklenmektedir.

Anahtar Kelimeler

Two-year Experience with balloon-Expandable Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis at a Tertiary Center

Abstract

Objective Aortic stenosis (AS) is the most common valvular heart disease requiring intervention, particularly in developed countries. Transcatheter aortic valve replacement (TAVR) is indicated for patients with a high surgical risk and a post-procedural survival expectancy of more than 12 months. Over the years, the TAVR method has emerged as a significant treatment option for patients with symptomatic severe AS and has begun to be implemented in our country as well. The objective of this study was to evaluate the short and long-term outcomes of patients undergoing TAVR at our center, as well as to assess our institution's experience with the TAVR procedure. Methods This retrospective, single-center analysis included 16 consecutive patients with symptomatic AS who underwent TAVR between March 2022 and February 2024. All patients included in the study underwent implantation of a balloon-expandable TAVR valve. In the study, the demographic characteristics of patients preoperatively and during post-procedural follow-ups, their clinical status preoperatively and postoperatively, and echocardiographic findings were evaluated and compared. Results The mean age of the entire population was 78.3 ± 8.7 years, and 50% were women. Transfemoral access was used in 93.8% of patients. Implantation success was achieved in all cases. During the TAVI procedure, 12.5% of patients required permanent pacemaker implantation. The mean length of hospital stay for the entire cohort was 4.5±2.3 days. There wasn’t show in-hospital deaths occurred before hospital discharge. During the follow-up, it was observed that 3 patients died from all-cause mortality. The mean follow-up duration of the study was 552 days, with the longest follow-up being 666 days. The significant improvement was noted in all echocardiographic parameters and functional capacity. No cases with moderate or severe aortic regurgitation, necessitating additional procedures. Conclusion Our center results with TAVR over a 2-year span consistent with broader studies. Despite some procedure-related complications, advancements in devices and techniques are expected to reduce these, enhancing outcomes with increased procedural experience. With medicine favoring less invasive approaches, TAVR is poised to become a more prevalent alternative to surgery across diverse patient cohorts.

Keywords

Kaynakça

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Ayrıntılar

Birincil Dil

İngilizce

Konular

Sağlık Hizmetleri ve Sistemleri (Diğer)

Bölüm

Araştırma Makalesi

Yazarlar

Anıl Şahin ^*
0000-0003-3416-5965
Türkiye

Ahmet Caner Canpolat
0009-0006-9395-5325
Türkiye

Enes Gül
0000-0002-5562-2697
Türkiye

İdris Buğra Çerik
0000-0003-1419-3950
Türkiye

İbrahim Gül
0000-0003-1007-0961
Türkiye

Yayımlanma Tarihi

29 Haziran 2024

Gönderilme Tarihi

29 Nisan 2024

Kabul Tarihi

8 Haziran 2024

Yayımlandığı Sayı

Yıl 2024 Cilt: 46 Sayı: 2

DOI

https://doi.org/10.7197/cmj.1474981

IZ

https://izlik.org/JA78PP62XB

Kaynak Göster

RIS / Bibtex

AMA

1.Şahin A, Canpolat AC, Gül E, Çerik İB, Gül İ. Two-year Experience with balloon-Expandable Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis at a Tertiary Center. CMJ. 2024;46(2):129-135. doi:10.7197/cmj.1474981