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Transcatheter aortic valve implantation: initial experience in Hong Kong
M Ky Lee1, S F Chui1, A Kc Chan1
1Department of Medicine, Queen Elizabeth Hospital, Jordan, Hong Kong.
Insights
Transcatheter aortic valve implantation (TAVI) offers a promising alternative for severe aortic stenosis patients unsuitable for surgery. This study in Hong Kong showed TAVI improved valve area and function with acceptable safety outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Aortic stenosis is a prevalent valvular heart disease in aging populations.
- Severe symptomatic aortic stenosis poses a high risk of mortality.
- Surgical aortic-valve replacement is standard but often not feasible for elderly or comorbid patients.
Purpose of the Study:
- To evaluate the efficacy and safety of transcatheter aortic valve implantation (TAVI).
- To assess TAVI outcomes in the Hong Kong Chinese population with severe aortic stenosis.
Main Methods:
- Retrospective analysis of 56 patients undergoing TAVI from December 2010 to September 2015.
- Data collection included baseline characteristics, procedural details, and 1-year clinical outcomes.
- Focus on efficacy (valve area, NYHA class) and safety (complications, mortality).
Main Results:
- Significant improvement in mean aortic valve area (0.70 to 1.94 cm²).
- 92% of patients improved by at least one NYHA functional class.
- Low rates of stroke (1.8%) and hospital mortality (1.8%); 1-year all-cause mortality was 12.5%.
Conclusions:
- TAVI is a viable alternative for high-risk or inoperable patients with severe aortic stenosis.
- The procedure demonstrated promising efficacy and safety in this Hong Kong cohort.
- Outcomes are comparable to major international clinical trials.
Introduction:
Aortic stenosis is one of the most common valvular heart diseases in the ageing population. Patients with symptomatic severe aortic stenosis are at high risk of sudden death. Surgical aortic-valve replacement is the gold standard of treatment but many patients do not receive surgery because of advanced age or co-morbidities. Recently, transcatheter aortic valve implantation has been developed as an option for these patients. This study aimed to assess efficacy and safety of this procedure in the Hong Kong Chinese population.
Methods:
Data for baseline patient characteristics, procedure parameters, and clinical outcomes up to 1-year post-implantation in a regional hospital in Hong Kong were collected and analysed.
Results:
A total of 56 patients with severe aortic stenosis underwent the procedure from December 2010 to September 2015. Their mean (± standard deviation) age was 81.9 ± 4.8 years; 64.3% of them were male. Their mean logistic EuroSCORE was 22.6% ± 13.4%. After implantation, the mean aortic valve area improved from 0.70 cm2 ± 0.19 cm2 to 1.94 cm2 ± 0.37 cm2. Of the patients, 92% were improved by at least one New York Heart Association functional class. Stroke and major vascular complications occurred in one (1.8%) and five (8.9%) patients, respectively. A permanent pacemaker was implanted in seven (12.5%) patients. Both hospital and 30-day mortalities were 1.8%. The 1-year all-cause and cardiovascular mortality rates were 12.5% and 7.1%, respectively.
Conclusions:
Transcatheter aortic valve implantation has been developed as an alternative treatment for patients with symptomatic severe aortic stenosis who are deemed inoperable or high risk for surgery. Our results are very promising and comparable with those of major clinical trials.
