Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach
Received 22 November 2017
Accepted for publication 17 April 2018
Published 10 July 2018 Volume 2018:9 Pages 21—27
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Cristina Weinberg
Peer reviewer comments 3
Editor who approved publication: Professor David B Price
Vasileios Patris,1 Konstantinos Giakoumidakis,1 Mihalis Argiriou,1 Katerina K Naka,2 Efstratios Apostolakis,3 Mark Field,4 Manoj Kuduvalli,4 Aung Oo,4 Stavros Siminelakis3
1Department of Cardiac Surgery, “Evangelismos” General Hospital of Athens, Athens, Greece; 2Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece; 3Department of Cardiothoracic Surgery, University of Ioannina, Ioannina, Greece; 4Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
Purpose: To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them.
Patients and methods: A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008–October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital’s electronic database.
Results: The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity.
Conclusion: It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.
Keywords: aortic valve stenosis, complications, retrospective studies, transcatheter aortic valve replacement
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