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Master Thesis

Le rétrécissement aortique en 2017 : revue des connaissances et évolution dans la prise en charge 15 ans après la première implantation d’une valve aortique par voie percutanée chez l’homme. Analyse de la cohorte rouennaise, suivi à long-terme durabilité

Abstract : Background: Since the first in man trancatheter aortic valve implantation (TAVI) in Rouen in 2002, TAVI has been spreading worldwide. While indications of TAVI are expanding, our cohort represents the longest follow-up available. We aimed to analyze short- and long-term survival, complications and valve durability after TAVI. Methods: Since 2002, all TAVI patients were included in our institutional database. We performed 30-day and yearly clinical and echocardiographic follow-up. Outcome were assessed according to VARC-2 criteria, valve deterioration was analyzed taking into account the competitive risk of death. Risk factors for death were assessed by multivariate analysis. Results: We included 1147 patients and only ten (0.8%) were lost for follow-up. The transseptal, transfemoral and non-percutaneous approaches represented respectively 2.9% (34 patients), 77.5% (885 patients) and 15.4% (177 patients). The mean age was 83.8 ±6.5. From the first to last generation of prosthesis, mean Logistic EuroSCORE decreased from 30.1% to 15.5%, major vascular complications decreased from 14% to 5.6%, 30-day mortality from 17.4% to 3.3%. Hospital stay was shorter from 9.6 ±5.9 to 4.7 ±7.9 days. Incidence of aortic regurgitation (AR) ≥ grade 2 decreased from 21.5% to 8.2%. The median time to death was 3.5 years, survival at 7-year was 16.6%. Longest follow-up was 11 years. Independent risk factors for long-term death were NYHA≥3, hemodialysis, atrial fibrillation, low mean aortic gradient and severe mitral regurgitation at baseline, grade ≥ 2 AR at discharge, major vascular complication and procedure failure. Cumulative risk of valve deterioration was 3.7% (CI95 1.8 – 6.8%) at 10 years. Three patients only presented with severe deterioration leading to successful reintervention in two. Conclusion: TAVI is a safe and durable alternative for inoperable or high-risk patients. There is no warning regarding long-term outcome or valve deterioration according to our experience.
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https://dumas.ccsd.cnrs.fr/dumas-01665282
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Submitted on : Friday, December 15, 2017 - 4:35:09 PM
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Guillaume Avinée. Le rétrécissement aortique en 2017 : revue des connaissances et évolution dans la prise en charge 15 ans après la première implantation d’une valve aortique par voie percutanée chez l’homme. Analyse de la cohorte rouennaise, suivi à long-terme durabilité. Médecine humaine et pathologie. 2017. ⟨dumas-01665282⟩

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