Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To study the effect of transcatheter aortic valve implantation (TAVI), performed by different types of prostheses and various surgical access, on the prognosis of patients with critical aortic stenosis and comorbidities.

Material and methods. Patients (n=130) that had consistently performed 80 TAVI by Edwards valve transfemoral (n=50) and transapical (n=30) access, as well as 50 transcatheter aortic valve replacement by CoreValve system were included into the study. Complications including perioperative mortality, total 30-day mortality, as well as post-hospital mortality were registered during aortic valve replacement, immediately after surgery, before the expiry of 30 days. Mean follow-up was 2.2 years (range 0.2 to 5.2 years).

Results. Hospital mortality was on average 6.9%. 121 patients had been discharged from the department after the surgery. The number of deaths in the post-hospital period was 14.8%. Valve type and the type of access had no effect on post-hospital mortality. Men died more than 2.5 times often than women, regardless of age. Atrioventricular block, pacemaker implantation, and history of chronic obstructive pulmonary disease were the most significant prognostic factors. An important role of minor stroke and renal failure should be noted. Mortality did not depend on the surgical access or valve type. All parameters characterizing the intervention were significantly associated with mortality, both during and after surgery. The proportion of survivors at the end of the first year of observation using Corvalve system was 86.9%, Edwards valve by transfemoral access - 88% and Edwards valve by transapical access – 85.4% (insignificant differences for all groups, p>0.05). Two-year survival was 77.5%, 82.5% and 82.7%, respectively (also insignificant differences for all groups, p>0.05).

Conclusion. TAVI is the method of choice, reasonable alternative approach for surgical valve replacement in patients with high surgical risk, although mortality after TAVI is still quite high and amounted to 6.9% in our study. It makes it possible to extend life and improve its quality that is of great social importance in the global trend of an aging population.

About the Authors

T. E. Imaev
Russian Cardiology Research and Production Complex
Russian Federation

Timur E. Imaev – MD, PhD, Leading Researcher, Cardiovascular Surgery Department. 

Tretya Cherepkovskaya ul. 15a, Moscow, 121552

A. E. Komlev
Russian Cardiology Research and Production Complex
Russian Federation
Alexey E. Komlev – MD, Cardiologist, Cardiovascular Surgery Department

R. S. Akchurin
Russian Cardiology Research and Production Complex
Russian Federation
Renat S. Akchurin – MD, PhD, Professor, Academician of the Russian Academy of Sciences, Head of Cardiovascular Surgery Department


1. Rosenhek R., Binder T., Porenta G., et al. Predictors of outcome in severe, asymptomatic aortic stenosis. N Engl J Med. 2000;343:611-7.

2. Rosenhek R., Zilberszac R., Schemper M., et al. Natural history of very severe aortic stenosis. Circulation. 2010;121:151-6.

3. Petrovsky B.V., Solovyov G.M., Shumakov V.I. Prosthetic heart valves. Moscow: Medicine; 1966 (In Russ.) [Петровский Б.В., Соловьев ГМ., Шумаков В.И. Протезирование клапанов сердца. М: Медицина; 1966].

4. Hufnagel C.A., Harvey W.P. Aortic plastic valvular prosthesis. Bull Georgetown Univ Med Center. 1952;4:1.

5. Mack M.J., Holmes D.R., Webb J., et al. Patient selection for transcatheter aortic valve replacement. J Am Coll Cardiol. 2013;62:S1-10.

6. Panchal H.B., Ladia V., Amin P., et al. A meta-analysis of mortality and major adverse cardiovascular and cerebrovascular events in patients undergoing transfemoral versus transapical transcatheter aortic valve implantation using edwards valve for severe aortic stenosis. Am J Cardiol. 2014;114(12):1882-90.

7. Bleiziffer S., Ruge H., Mazzitelli D., et al. Survival after transapical and transfemoral aortic valve implantation: talking about two different patient populations. J Thorac Cardiovasc Surg. 2009;38(5):1073-80.

8. Buellesfeld L., Wenaweser P., Gerckens U., et al. Transcatheter aortic valve implantation: predictors of procedural success-the Siegburg-Bern experience. Eur Heart J. 2010;31(8):984-91.

9. Rodes-Cabau J., Dumont E., De LaRochelliere R., et al. Feasibility and initial results of percutaneous aortic valve implantation including selection of the transfemoral or transapical approach in patients with severe aortic stenosis. Am J Cardiol. 2008;102(9):1240-6.

10. Sabate M., Sergio Canovas S., Garcıa E., et al and collaborators of the TAVI National Group. In-hospital and Mid-term Predictors of Mortality After Transcatheter Aortic Valve Implantation: Data From the TAVI National Registry 2010-2011. Rev Esp Cardiol. 2013;66(12):949-58.

11. Rodeґs-Cabau J., Webb J.G., Cheung A., et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. J Am Coll Cardiol. 2010;55:1080-90.

12. Kodali S., Williams M.R., Doshi D., et al. Sex-specific differences at presentation and outcomes among patients undergoing transcatheter aortic valve replacement: A cohort study. Ann Intern Med. 2016: 377-384.

13. Webb J.G., Altwegg L., Boone R.H., Cheung A., et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009;119:3009-16.

14. Sinning J.M., Ghanem A., Steinhauser H., et al. Renal function as predictor of mortality in patients after percutaneous transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2010;3:1141-9.

15. Holmes D.R. Jr., Brennan J.M., Rumsfeld J.S., et al. Clinical outcomes at 1 year following transcatheter aortic valve replacement. JAMA. 2015;313:1019-28.

16. Leon M., Smith C.R., Mack M.J., et al. Transcatheter or surgical aortic-valve replacement in intermediaterisk patients. N Engl J Med. 2016.2016; 374(17):1609-20.


For citations:

Imaev T.E., Komlev A.E., Akchurin R.S. THE PROGNOSIS IN TRANSCATHETER AORTIC VALVE IMPLANTATION. Rational Pharmacotherapy in Cardiology. 2016;12(6):718-724. (In Russ.)

Views: 606

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)