Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Introduction: Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center.
Materials and methods: Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices.
Results: Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%).
Conclusions: TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.

doi: 10.1016/j.ijcha.2021.100817.

引言：根据近期数据，经皮主动脉瓣植入术（TAVI）的适应症正在扩展至手术风险较低的个体，这些个体通常比既往接受严重主动脉瓣狭窄治疗的患者年轻。事实上，年轻患者传统上在当前的TAVI文献中代表性不足。本研究旨在报告在一所高容量中心接受TAVI的70岁以下患者的临床特征、手术结果和中期结果。材料与方法：将2007年至2019年间在一所单一的三级转诊中心接受TAVI治疗严重、有症状的主动脉瓣狭窄的70岁以下连续患者纳入本研究。分析了手术和中期结果，比较了第一代与第二代装置。结果：在2007年至2019年间，我们的中心共进行了1740例TAVI手术。在这些患者中，129名（7.4%）患者在干预时年龄小于70岁，并被纳入本次分析。其中58名患者（45%）植入了一代人工瓣膜，而71名患者（55%）植入了两代人工瓣膜。导致该人群采用经皮途径的原因包括：既往冠状动脉旁路移植术（27.9%）；瓷化主动脉（24%）；严重左心室收缩功能障碍（21.7%）；既往胸部放疗（19.4%）；严重肺部疾病（8.5%）；血流动力学不稳定（7.0%）；晚期肝病（4.6%）和活动性癌症（3.9%）。总体装置成功率为89%，第一代和第二代装置之间无差异。三年全因死亡率34%，两组之间无差异。在中期随访中发现主动脉瓣再次干预发生率较低（晚期瓣膜再干预=2.3%）。结论：对于有适当干预指征的年轻患者，TAVI是一种安全的手术，与医院内死亡率低和严重并发症发生率低有关，无论是第一代还是第二代装置。在考虑长期耐用性时，需要更多数据；在我们的病例系列中，长期随访显示良好的生存率，以及极低的瓣膜再干预率。