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Irish Journal of Medical Science (1971 -)

, Volume 183, Issue 4, pp 653–657 | Cite as

Experience of a high-risk aortic valve clinic in Ireland

  • K. E. O’Sullivan
  • S. A. Early
  • I. Casserly
  • Z. Chugtai
  • D. Sugrue
  • J. Hurley
Original Article

Abstract

Background

The advent of transcatheter aortic valve implantation (TAVI) has broadened the management options for severe aortic stenosis. The indications for TAVI are narrow. Selecting those that will benefit most from this intervention warrants careful consideration and input from cardiologists, anaesthetists and cardiac surgeons familiar with TAVI and surgical aortic valve replacement (SAVR).

Aims

The aims of this paper were to assess the feasibility of establishing a high-risk aortic clinic in Ireland, and report stratification of the referred group into those suitable for SAVR, TAVI and conservative management.

Methods

Patient data was prospectively collected by a dedicated clinical nurse specialist. ANOVA was used to assess variance in means between groups. Analyses were performed using IBM SPSS v20 (Armonk, NY: IBM Corp.).

Results

A total of 105 patients were assessed. Eighty-five patients were deemed suitable for TAVI, 9 (10.5 %) died awaiting the procedure and a further 6 (7 %) declined intervention. Eleven (10.5 %) underwent conventional SAVR, 1 (0.9 %) a balloon valvuloplasty, 4 (3.8 %) entered surveillance and 4 (3.8 %) were declined treatment.

Conclusions

Establishment of a high-risk aortic clinic is feasible in the Irish context. The advent of TAVI has reduced the proportion of patients denied intervention to a minority. Despite being considered high risk, a number of patients were suitable candidates for SAVR. Measuring frailty continues to provide a challenge; a TAVI-specific frailty assessment tool would be advantageous to patient stratification.

Keywords

Transcatheter Aortic Valve Implantation Clinic 

References

  1. 1.
    Carabello BA, Paulus WJ (2009) Aortic stenosis. Lancet 373(9667):956–966PubMedCrossRefGoogle Scholar
  2. 2.
    Lindroos M, Kupari M, Heikkila J, Tilvis R (1993) Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 21(5):1220–1225PubMedCrossRefGoogle Scholar
  3. 3.
    Horstkotte D, Loogen F (1988) The natural history of aortic valve stenosis. Eur Heart J Suppl E:57–64CrossRefGoogle Scholar
  4. 4.
    Lindblom D, Lindblom U, Qvist J, Lundstrom H (1990) Long-term relative survival rates after heart valve replacement. J Am Coll Cardiol 15(3):566–573PubMedCrossRefGoogle Scholar
  5. 5.
    Svensson LG, Adams DH, Bonow RO, Kouchoukos NT, Miller DC, O’Gara PT et al (2013) Aortic valve and ascending aorta guidelines for management and quality measures: executive summary. Ann Thorac Surg 95(4):1491–1505PubMedCrossRefGoogle Scholar
  6. 6.
    Charlson E, Legedza AT, Hamel MB (2006) Decision-making and outcomes in severe symptomatic aortic stenosis. J Heart Valve Dis 15(3):312–321PubMedGoogle Scholar
  7. 7.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW et al (2003) A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J 24(13):1231–1243PubMedCrossRefGoogle Scholar
  8. 8.
    Health Do. Health in Ireland, Key Trends in 20122012Google Scholar
  9. 9.
    Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG et al (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607PubMedCrossRefGoogle Scholar
  10. 10.
    Roques F, Nashef SA, Michel P, Gauducheau E, de Vincentiis C, Baudet E (1999) Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg 15(6):816–822 (discussion 22–23)PubMedCrossRefGoogle Scholar
  11. 11.
    Shroyer AL, Grover FL, Edwards FH (1998) 1995 coronary artery bypass risk model: the Society of Thoracic Surgeons Adult Cardiac National Database. Ann Thorac Surg 65(3):879–884PubMedCrossRefGoogle Scholar
  12. 12.
    Green CP, Porter CB, Bresnahan DR, Spertus JA (2000) Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol 35(5):1245–1255PubMedCrossRefGoogle Scholar
  13. 13.
    Cribier A (2012) Development of transcatheter aortic valve implantation (TAVI): a 20-year odyssey. Arch Cardiovasc Dis 105(3):146–152PubMedCrossRefGoogle Scholar
  14. 14.
    Safian RD, Berman AD, Diver DJ, McKay LL, Come PC, Riley MF et al (1988) Balloon aortic valvuloplasty in 170 consecutive patients. N Engl J Med 319(3):125–130PubMedCrossRefGoogle Scholar
  15. 15.
    Percutaneous balloon aortic valvuloplasty (1991) Acute and 30-day follow-up results in 674 patients from the NHLBI Balloon Valvuloplasty Registry. Circulation 84(6):2383–2397CrossRefGoogle Scholar
  16. 16.
    Otto CM, Mickel MC, Kennedy JW, Alderman EL, Bashore TM, Block PC et al (1994) Three-year outcome after balloon aortic valvuloplasty. Insights into prognosis of valvular aortic stenosis. Circulation 89(2):642–650PubMedCrossRefGoogle Scholar
  17. 17.
    Vahanian A, Himbert D, Brochet E, Depoix JP, Iung B, Nataf P (2012) Transcatheter aortic valve implantation: our vision of the future. Arch Cardiovasc Dis 105(3):181–186PubMedCrossRefGoogle Scholar
  18. 18.
    Bainey KR, Natarajan MK, Mercuri M, Lai T, Teoh K, Chu V et al (2013) Treatment assignment of high-risk symptomatic severe aortic stenosis patients referred for transcatheter aorticvalve implantation. Am J Cardiol 112(1):100–103PubMedCrossRefGoogle Scholar
  19. 19.
    Fairbairn TA, Meads DM, Hulme C, Mather AN, Plein S, Blackman DJ et al (2013) The cost-effectiveness of transcatheter aortic valve implantation versus surgical aortic valve replacement in patients with severe aortic stenosis at high operative risk. Heart 99(13):914–920PubMedCrossRefGoogle Scholar
  20. 20.
    Ranucci M, Guarracino F, Castelvecchio S, Baldassarri R, Covello RD, Landoni G (2010) Surgical and transcatheter aortic valve procedures. The limits of risk scores. Interact Cardiovasc Thorac Surg 11(2):138–141PubMedCrossRefGoogle Scholar
  21. 21.
    Mack M (2013) Frailty and aortic valve disease. J Thorac Cardiovasc Surg 145(3 Suppl):S7–S10PubMedCrossRefGoogle Scholar
  22. 22.
    Green P, Cohen DJ, Genereux P, McAndrew T, Arnold SV, Alu M (2013) Relation between six-minute walk test performance and outcomes after transcatheter aortic valve implantation (from the PARTNER Trial). Am J Cardiol. doi: 10.1016/j.amjcard.2013.04.046 Google Scholar
  23. 23.
    Polidoro A, Stefanelli F, Ciacciarelli M, Pacelli A, Di Sanzo D, Alessandri C (2013) Frailty in patients affected by atrial fibrillation. Arch Gerontol Geriatr. doi: 10.1016/j.archger.2013.04.014 PubMedGoogle Scholar
  24. 24.
    Arnold SV, Spertus JA, Lei Y, Allen KB, Chhatriwalla AK, Leon MB et al (2013) Use of the Kansas City Cardiomyopathy Questionnaire for monitoring health status in patients with aortic stenosis. Circ Heart Fail 6(1):61–67PubMedCrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • K. E. O’Sullivan
    • 1
  • S. A. Early
    • 1
  • I. Casserly
    • 1
  • Z. Chugtai
    • 1
  • D. Sugrue
    • 1
  • J. Hurley
    • 1
  1. 1.Mater Misericordiae University Hospital, Mater Private HospitalDublin 7Ireland

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