Résumé
The aim of the study was to evaluate feasibility and safety of transcatheter aortic valve implantation (TAVI) performed without subsequent intensive care unit (ICU) admission using simple clinical, ECG and echocardiographic criteria.
We included prospectively 177 consecutive patients who underwent TAVI in our center. Low-risk patients, admitted to conventional cardiology unit, had stable clinical state, LVEF > 40%, transfemoral access, no right bundle branch block (RBBB), permanent pacing with self-expandable valve and no complication during the procedure. High-risk group included other patients who were transferred to ICU. The primary endpoint concerned in-hospital events (VARC-2 criteria).
Mean age of patients was 83.5±6.5 years and mean logistic Euroscore was 14.6±9.7%. The balloon expandable SAPIENS 3 valve was mainly used (n=148; 83.6%), mostly with transfemoral access (n=167; 94,4%). Among the 61 patients (34.5%) included in the low-risk group, only 1 (1.6%) had a minor complication (NPV: 98.4%; 95% CI: 0.91-0.99). Conversely, 47 patients (40.5%) from the high-risk group had clinical events (PPV: 40.5%; 95% CI: 0.31-0.50), mainly conductive disorders requiring pacemaker (n=26; 22.4%). In multivariate analysis, RBBB (OR: 14.1; 95% CI: 3.5-56.3), use of self-expandable valve without pacemaker (OR: 5.5; 95% CI: 2-16.3), vitamin K antagonist treatment (OR: 3.8; 95% CI: 1.1-12.6) and female gender (OR: 2.6; 95% CI 1.003-6.9) were pre-procedural predictive factors of in-hospital adverse events.
Our results suggested that TAVI can be performed safely without ICU admission in selected patients. This strategy may optimize efficiency and cost-effectiveness of the procedure.
The author hereby declares no conflict of interestTableIn hospital major adverse events in the two groups of patients.Post TAVI adverse eventsLow risk group (n=61; 34.5%)High risk group (n=116: 65.5%)Death (n=1; 0.6%)01 (0.9%)Acute pulmonary oedema (n=1; 0.6%)01 (0.9%)New high conductive disorder(n=36; 20.2%)036 (31%)Permanent pacing requiring(n=26; 14.7%)026 (22.4%)Major vascular complication(n=1; 0.6%)01 (0.9%)Pericardial effusion requiring medical intervention(n=2; 1.2%)02 (1.8%)Acute kidney injury (Akin 2 or 3)(n=3; 1.8%)03 (2.7%)Secondary transfer to ICU (n=1) (pericardial effusion)1 (1.6%)Total of patient with at least one complication (n=48; 27.1%)1 (1.6%)47 (40.5%)