Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Marco B Ancona; Evelina Toscano; Francesco Moroni; Luca A Ferri; Filippo Russo; Barbara Bellini; Antonio Sorropago; Caterina Mula; Costanza Festorazzi; Marco Gamardella; Ciro Vella; Alessandro Beneduce; Vittorio Romano; Igor Belluschi; Nicola Buzzatti; Eustachio Agricola; Matteo Montorfano

doi:10.1016/j.ijcha.2021.100817

Patients younger than 70 undergoing transcatheter aortic valve implantation: Procedural outcomes and mid-term survival

Int J Cardiol Heart Vasc. 2021 Jun 9:34:100817. doi: 10.1016/j.ijcha.2021.100817. eCollection 2021 Jun.

Authors

Marco B Ancona¹, Evelina Toscano^{1

2}, Francesco Moroni¹, Luca A Ferri¹, Filippo Russo¹, Barbara Bellini¹, Antonio Sorropago², Caterina Mula¹, Costanza Festorazzi¹, Marco Gamardella¹, Ciro Vella¹, Alessandro Beneduce¹, Vittorio Romano¹, Igor Belluschi³, Nicola Buzzatti³, Eustachio Agricola⁴, Matteo Montorfano¹

Affiliations

¹ Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
² Interventional Cardiology Department, Policlinico di Monza, Monza, Italy.
³ Heart Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁴ Cardiovascular Imaging Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.

Abstract

Introduction: Based on recent data, the indication for transcatheter aortic valve implantation (TAVI) is expanding to individuals at lower surgical risk, who are generally younger than subjects historically treated for severe aortic stenosis. Indeed, younger patients have traditionally been under-represented in current TAVI literature. The aim of the present study is to report about clinical features, procedural outcomes and mid-term outcomes of patients younger than 70 who underwent TAVI in a single high-volume center.

Materials and methods: Consecutive patients younger than 70 years of age who underwent TAVI for severe, symptomatic aortic stenosis between 2007 and 2019 at a single, tertiary referral center have been included in this retrospective study. Procedural and mid-term outcomes were analyzed, comparing 1st generation with 2nd generation devices.

Results: Between 2007 and 2019, 1740 TAVI procedures were performed in our center. Among these, one hundred twenty-nine (7.4%) patients were younger than 70 years at the time of the intervention and were included in the present analysis. Fifty-eight patients (45%) were implanted with a 1st generation prosthesis while seventy-one patients (55%) were implanted with a 2nd generation device. Reasons which lead to a transcatheter approach in this population were: previous CABG (27.9%); porcelain aorta (24%); severe left ventricular systolic dysfunction (21.7%); prior chest radiation (19.4%); severe lung disease (8.5%); hemodynamic instability (7.0%); advanced liver disease (4.6%) and active cancer (3.9%). Overall device success rate was 89%, with no differences among 1st and 2nd generation devices. Threeyears all-cause mortality was 34%, with no difference among the two groups. Low incidence of aortic-valve re-intervention was observed at mid-term follow-up (late valve re-intervention = 2.3%).

Conclusions: TAVI in young patient with appropriate indication for intervention is a safe procedure, associated with low rate of in hospital mortality and low rate of severe complications both with 1st and with 2nd generation devices. When considering long term durability, more data are needed; in our case series long-term follow up shows a good survival and also an extremely low rate of valve re-intervention.

Keywords: Aortic stenosis; BEV, balloon expandable valve; CABG, coronary artery bypass graft; High risk; SAVR, surgical aortic valve replacement; SEV, self expandable valve; TAVI, transcatheter aortic valve implantation; THV, transcatheter heart valve; Transcatheter aortic valve implantation; Transcatheter heart valve; Young population.