Single center experience with transcatheter aortic valve implantation using the Edwards SAPIEN™ Valve

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Transcatheter aortic valve implantation (TAVI) emerged in the early 2000s for high-risk aortic stenosis patients unsuitable for surgery.
• TAVI procedures have significantly increased, with widespread adoption in cardiac centers.
• This study details a single center's initial experience with 100 TAVI procedures.

Purpose of the Study:

• To evaluate the outcomes of the first 100 transcatheter aortic valve implantation (TAVI) procedures at a single center.
• To assess the feasibility, safety, and efficacy of TAVI in high-risk patients.
• To identify any learning curve associated with TAVI implementation.

Main Methods:

• A cohort of 100 patients undergoing either transfemoral (F-TAVI) or transapical (A-TAVI) implantation using the Edwards SAPIEN™ valve.
• Patient selection based on predicted high risk for conventional surgery and iliac artery diameter.
• Data collected on procedural success, mortality, complications, and functional status.

Main Results:

• Successful implantation in 92% of patients; 30-day mortality was 8%, decreasing from 12% to 4% over the study period.
• Major non-fatal complications occurred in 5% of A-TAVI patients versus 0% in F-TAVI patients.
• Significant improvement in NYHA class (from 2.9 to 1.8, p < 0.001) was observed, with no difference between F-TAVI and A-TAVI.

Conclusions:

• TAVI is a viable option for high-risk patients, offering acceptable mortality and morbidity with substantial functional gains.
• The observed reduction in 30-day mortality suggests a learning curve, highlighting the importance of experience in TAVI programs.
• Both transfemoral and transapical approaches demonstrated functional improvement, though complication rates differed between the two methods.