Skip to main content

Clinical experience with trans-catheter aortic valve implantation at a tertiary hospital in the Republic of Ireland

Abstract

Introduction

There is a paucity of published data on the clinical experience with trans-catheter aortic valve implantation (TAVI) in the Republic of Ireland. We sought to examine the clinical outcomes of patients with medium-term follow-up treated with TAVI at our institution.

Methods

A prospective TAVI registry was used to assess the baseline demographics, procedural variables and clinical outcomes of patients treated with TAVI between the inception of the programme in 2008 and November 2017.

Results

A total of 354 patients (mean age 80.9 ± 8.1 years, 58% male, mean STS score 6.1 ± 4.3%) were treated during the study period. Major in-hospital outcomes included in-lab death (n = 2, 0.6%), stroke (n = 8, 2.2%), device embolisation (n = 4, 1.2%), permanent pacemaker implantation (n = 22, 6.2%) and major vascular complication (n = 2, 0.6%). The median length of hospital stay was 4 days (IQR 2–8 days). The Kaplan-Meier estimate of freedom from death at 30 days and 1 year for the entire cohort was 97 ± 1% and 85.4 ± 2.3%, respectively. Trans-femoral access was associated with a significantly lower rate of death and/or stroke at 1 year compared to trans-apical access (84.9 ± 2.4% versus 60 ± 8.9%, p = 0.0005). There was no significant difference in freedom from death and/or stroke at 1 year between balloon-expandable and self-expanding valves (81.6 ± 2.6% versus 84.4 ± 7.4%, p = 0.63).

Conclusion

This study documents low complication rates and favourable rates of survival following TAVI in a consecutive series of patients undergoing TAVI at a tertiary referral centre in the Republic of Ireland. These data support the application of this therapy in the Irish context.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. Baumgartner H, Falk V, Bax JJ, de Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, ESC Scientific Document Group, Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet JP, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GMC, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa-Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V, Windecker S, Aboyans V, Agewall S, Barbato E, Bueno H, Coca A, Collet JP, Coman IM, Dean V, Delgado V, Fitzsimons D, Gaemperli O, Hindricks G, Iung B, Jüni P, Katus HA, Knuuti J, Lancellotti P, Leclercq C, McDonagh T, Piepoli MF, Ponikowski P, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Zamorano JL, Kzhdryan HK, Mascherbauer J, Samadov F, Shumavets V, Camp GV, Lončar D, Lovric D, Georgiou GM, Linhartova K, Ihlemann N, Abdelhamid M, Pern T, Turpeinen A, Srbinovska-Kostovska E, Cohen A, Bakhutashvili Z, Ince H, Vavuranakis M, Temesvári A, Gudnason T, Mylotte D, Kuperstein R, Indolfi C, Pya Y, Bajraktari G, Kerimkulova A, Rudzitis A, Mizariene V, Lebrun F, Demarco DC, Oukerraj L, Bouma BJ, Steigen TK, Komar M, de Moura Branco LM, Popescu BA, Uspenskiy V, Foscoli M, Jovovic L, Simkova I, Bunc M, de Prada JAV, Stagmo M, Kaufmann BA, Mahdhaoui A, Bozkurt E, Nesukay E, Brecker SJD (2017) 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791

    Article  Google Scholar 

  2. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ, PARTNER Trial Investigators (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198

    CAS  Article  Google Scholar 

  3. Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali SK, Thourani VH, Tuzcu EM, Miller DC, Herrmann HC, Doshi D, Cohen DJ, Pichard AD, Kapadia S, Dewey T, Babaliaros V, Szeto WY, Williams MR, Kereiakes D, Zajarias A, Greason KL, Whisenant BK, Hodson RW, Moses JW, Trento A, Brown DL, Fearon WF, Pibarot P, Hahn RT, Jaber WA, Anderson WN, Alu MC, Webb JG, PARTNER 2 Investigators (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374(17):1609–1620

    CAS  Article  Google Scholar 

  4. Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 376(14):1321–1331

    Article  Google Scholar 

  5. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J Jr, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK, U.S. CoreValve Clinical Investigators (2014) Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med 370(19):1790–1798

    CAS  Article  Google Scholar 

  6. Walther T, Hamm CW, Schuler G, Berkowitsch A, Kötting J, Mangner N, Mudra H, Beckmann A, Cremer J, Welz A, Lange R, Kuck KH, Mohr FW, Möllmann H, GARY Executive Board (2015) Perioperative results and complications in 15,964 transcatheter aortic valve replacements: prospective data from the GARY registry. J Am Coll Cardiol 65(20):2173–2180

    Article  Google Scholar 

  7. Holmes DR Jr, Nishimura RA, Grover FL et al (2015) Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT registry. J Am Coll Cardiol 66(25):2813–2823

    Article  Google Scholar 

  8. Bajrangee A, Coughlan JJ, Teehan S, O'Connor C, Murphy RT, Foley B, Daly C, Burke D, Maree AO, Crean PA (2017) Early and mid-term outcomes after transcatheter aortic valve implantation (TAVI) in Ireland. Int J Cardiol Heart Vasc 16:1–3

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Ad N, Holmes SD, Patel J, Pritchard G, Shuman DJ, Halpin L (2016) Comparison of EuroSCORE II, original EuroSCORE, and the society of thoracic surgeons risk score in cardiac surgery patients. Ann Thorac Surg 102(2):573–579

    Article  Google Scholar 

  10. Nashef SAM, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, Lockowandt U (2012) EuroSCORE II. Eur J Cardiothorac Surg 41(4):734–745

    Article  Google Scholar 

  11. Kappetein AP, Head SJ, Genereux P et al (2013) Updated standardized endpoint definitions for transcatheter aortic valve implantation: the valve academic research consortium-2 consensus document. J Thorac Cardiovasc Surg 145(1):6–23

    Article  Google Scholar 

  12. Ludman PF, Moat N, de Belder MA, Blackman DJ, Duncan A, Banya W, MacCarthy P, Cunningham D, Wendler O, Marlee D, Hildick-Smith D, Young CP, Kovac J, Uren NG, Spyt T, Trivedi U, Howell J, Gray H, UK TAVI Steering Committee and the National Institute for Cardiovascular Outcomes Research (2015) Transcatheter aortic valve implantation in the United Kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK transcatheter aortic valve implantation (TAVI) registry, 2007 to 2012. Circulation. 131(13):1181–1190

    Article  Google Scholar 

  13. Auffret V, Lefevre T, Van Belle E et al (2017) Temporal trends in transcatheter aortic valve replacement in France: FRANCE 2 to FRANCE TAVI. J Am Coll Cardiol 70(1):42–55

    Article  Google Scholar 

  14. Wendt D, Thielmann M, Kahlert P, Kastner S, Price V, al-Rashid F, Patsalis P, Erbel R, Jakob H (2014) Comparison between different risk scoring algorithms on isolated conventional or transcatheter aortic valve replacement. Ann Thorac Surg 97(3):796–802

    Article  Google Scholar 

  15. Rosenhek R, Iung B, Tornos P, Antunes MJ, Prendergast BD, Otto CM, Kappetein AP, Stepinska J, Kaden JJ, Naber CK, Acarturk E, Gohlke-Barwolf C (2012) ESC working group on valvular heart disease position paper: assessing the risk of interventions in patients with valvular heart disease. Eur Heart J 33(7):822–828 8a, 8b

    Article  Google Scholar 

  16. Bergmann L, Kahlert P, Eggebrecht H, Frey U, Peters J, Kottenberg E (2011) Transfemoral aortic valve implantation under sedation and monitored anaesthetic care—a feasibility study. Anaesthesia. 66(11):977–982

    CAS  Article  Google Scholar 

  17. Yamamoto M, Meguro K, Mouillet G, Bergoend E, Monin JL, Lim P, Dubois-Rande JL, Teiger E (2013) Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 111(1):94–99

    CAS  Article  Google Scholar 

  18. Fadahunsi OO, Olowoyeye A, Ukaigwe A, Li Z, Vora AN, Vemulapalli S, Elgin E, Donato A (2016) Incidence, predictors, and outcomes of permanent pacemaker implantation following transcatheter aortic valve replacement: analysis from the U.S. Society of Thoracic Surgeons/American College of Cardiology TVT Registry. JACC Cardiovasc Interv 9(21):2189–2199

    Article  Google Scholar 

  19. Abdel-Wahab M, Mehilli J, Frerker C, Neumann FJ, Kurz T, Tölg R, Zachow D, Guerra E, Massberg S, Schäfer U, el-Mawardy M, Richardt G, CHOICE investigators (2014) Comparison of balloon-expandable vs self-expandable valves in patients undergoing transcatheter aortic valve replacement: the CHOICE randomized clinical trial. Jama. 311(15):1503–1514

    Article  Google Scholar 

  20. Mohananey D, Jobanputra Y, Kumar A et al (2017) Clinical and echocardiographic outcomes following permanent pacemaker implantation after transcatheter aortic valve replacement: meta-analysis and meta-regression. Circ Cardiovasc Interv 10(7)

  21. Mohr FW, Holzhey D, Mollmann H et al (2014) The German Aortic Valve Registry: 1-year results from 13,680 patients with aortic valve disease. Eur J Cardiothorac Surg 46(5):808–816

    Article  Google Scholar 

  22. Gilard M, Eltchaninoff H, Donzeau-Gouge P, Chevreul K, Fajadet J, Leprince P, Leguerrier A, Lievre M, Prat A, Teiger E, Lefevre T, Tchetche D, Carrié D, Himbert D, Albat B, Cribier A, Sudre A, Blanchard D, Rioufol G, Collet F, Houel R, Dos Santos P, Meneveau N, Ghostine S, Manigold T, Guyon P, Grisoli D, le Breton H, Delpine S, Didier R, Favereau X, Souteyrand G, Ohlmann P, Doisy V, Grollier G, Gommeaux A, Claudel JP, Bourlon F, Bertrand B, Laskar M, Iung B, Gilard M, Laskar M, Eltchaninoff H, Fajadet J, Iung B, Teiger E, Donzeau-Gouge P, Leprince P, Leguerrier A, Prat A, Chevreul K, Lievre M, Bertrand M, Cassagne J, Boschat J, Lusson JR, Mathieu P, Logeais Y, Bessou JP, Lefevre T, Chevalier B, Farge A, Garot P, Hovasse T, Morice MC, Romano M, Gouge PD, Tchetche D, Vahdat O, Farah B, Fajadet J, Carrie D, Dumonteil N, Fournial G, Marcheix B, Himbert D, Nataf P, Vahanian A, Albat B, Leclercq F, Piot C, Schmutz L, Aubas P, du Cailar A, Dubar A, Durrleman N, Fargosz F, Levy G, Maupas E, Rivalland F, Robert G, Eltchaninoff H, Bessou JP, Cribier A, Tron C, Sudre A, Juthier F, Modine T, van Belle E, Banfi C, Blanchard D, Sallerin T, Bar O, Barbey C, Chassaing S, Chatel D, le Page O, Tauran A, Rioufol G, Cao D, Dauphin R, Durand de Gevigney G, Finet G, Jegaden O, Obadia JF, Leprince P, Beygui F, Collet JP, Pavie A, Collet F, Pecheux, Bayet, Vaillant A, Vicat J, Wittenberg O, Houel R, Joly P, Rosario R, Bergeron P, Bille J, Gelisse R, Teiger E, Couetil JP, Dubois Rande JL, Hayat D, Fougeres E, Monin JL, Mouillet G, Dos Santos P, Arsac F, Choukroun E, Dijos M, Guibaud JP, Leroux L, Elia N, Meneveau N, Descotes Genon, Chocron S, Schiele F, Caussin C, Azmoun A, Ghostine S, Nottin R, Tirouvanziam A, Crochet D, Gaudin R, Roussel JC, Guyon P, Bonnet N, Digne F, Mesnidrey P, Royer T, Stratiev V, Grisoli D, Bonnet JL, Cuisset T, Grisoli D, le Breton H, Abouliatim I, Bedossa M, Boulmier D, Verhoye JP, Delepine S, Debrux JL, Furber A, Pinaud F, Gilard M, Bezon E, Boschat J, Choplain JN, Favereau X, Bical O, Dambrin G, Deleuze P, Jegou A, Lusson JR, Azarnouch K, Durel N, Innorta A, Souteyrand G, Doisy V, Lienhart Y, Roriz R, Staat P, Blanchard D, Fabiani JN, Lafont A, Zegdi R, Heudes D, Ohlmann P, Kindo M, Mazzucotelli JP, Zupan M, Grollier G, Ivascau C, Lognone T, Massetti M, Sabatier R, Huret B, Gommeaux A, Hochart P, Pecheux, Claudel JP, Bouchayer D, Gabrielle F, Pelissier F, Tremeau G, Bourlon F, Dreyfus G, Eker A, Habib Y, Hugues N, Mialhe C, Bertrand B, Chavanon O, Porcu P, Vanzetto G (2016) Late outcomes of transcatheter aortic valve replacement in high-risk patients: the FRANCE-2 registry. J Am Coll Cardiol 68(15):1637–1647

    Article  Google Scholar 

  23. Holmes DR Jr, Brennan JM, Rumsfeld JS et al (2015) Clinical outcomes at 1 year following transcatheter aortic valve replacement. Jama. 313(10):1019–1028

    CAS  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Richard Tanner.

Ethics declarations

Ethical approval for this study was obtained from the Research Ethics Committee, Mater Misericordiae University Hospital (Ref: 1/378/1882 TMR).

Conflict of interest

Jana Boleckova is an employee of Edwards Lifesciences.

No other conflicts of interest to declare.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tanner, R., Moran, B., Margey, R. et al. Clinical experience with trans-catheter aortic valve implantation at a tertiary hospital in the Republic of Ireland. Ir J Med Sci 189, 139–148 (2020). https://doi.org/10.1007/s11845-019-02030-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-019-02030-7

Keywords

  • Aortic stenosis
  • Clinical outcomes
  • Ireland
  • TAVI
  • Trans-catheter aortic valve replacement