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Title: Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: Two-year Valve Academic Research Consortium-2 outcomes
Authors: Chew N.
Hon J.K.F. 
Yip W.L.J.
Chan S.P.
Poh K.-K.
Kong W.K.-F.
Teoh K.L.K. 
Yeo T.C.
Tan H.C.
Tay E.L.W.
Keywords: Aortic stenosis
Transcatheter aortic valve implantation
Issue Date: 1-Sep-2017
Publisher: Singapore Medical Association
Citation: Chew N., Hon J.K.F., Yip W.L.J., Chan S.P., Poh K.-K., Kong W.K.-F., Teoh K.L.K., Yeo T.C., Tan H.C., Tay E.L.W. (2017-09-01). Mid-term study of transcatheter aortic valve implantation in an Asian population with severe aortic stenosis: Two-year Valve Academic Research Consortium-2 outcomes. Singapore Medical Journal 58 (9) : 543-550. ScholarBank@NUS Repository.
Abstract: INTRODUCTION Transcatheter aortic valve implantation (TAVI) is an effective treatment for high-risk or inoperative patients with severe aortic stenosis. Given the unique characteristics of Asian populations, questions regarding mid-term outcomes in Asians undergoing TAVI have yet to be addressed. We evaluated the two-year clinical outcomes of TAVI in an Asian population using Valve Academic Research Consortium-2 definitions. METHODS This prospective study recruited 59 patients from a major academic medical centre in Singapore. The main outcomes were two-year survival rates, peri-procedural complications, symptom improvement, valvular function and assessment of learning curve. RESULTS Mean age was 76.8 years (61.0% male), mean body surface area 1.6 m2 and mean logistic EuroSCORE 18.7%. Survival was 93.2%, 86.0% and 79.1% at 30 days, one year and two years, respectively. At 30 days post TAVI, the rate of stroke was 1.7%, life-threatening bleeding 5.1%, acute kidney injury 25.0%, major vascular complication 5.1%, and new permanent pacemaker implantation 6.8%. 29.3% of TAVI patients were rehospitalised (47.1% cardiovascular-related) within one year. These composite outcomes were measured: device success (93.2%); early safety (79.7%); clinical efficacy (66.1%); and time-related valve safety (84.7%). Univariate analysis found these predictors of two-year all-cause mortality: logistic EuroSCORE (hazard ratio [HR] 1.07; p < 0.001); baseline estimated glomerular filtration rate (HR 0.97; p = 0.048); and acute kidney injury (HR 5.33; p = 0.022). Multivariate analysis identified non-transfemoral TAVI as a predictor of cardiovascular-related two-year mortality (HR 14.64; p = 0.008). CONCLUSION Despite the unique clinical differences in Asian populations, this registry demonstrated favourable midterm clinical and safety outcomes in Asians undergoing TAVI. � 2017, Singapore Medical Association. All rights reserved.
Source Title: Singapore Medical Journal
ISSN: 00375675
DOI: 10.11622/smedj.2016128
Appears in Collections:Staff Publications

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