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Minerva Cardiology and Angiology 2022 Mar 25

DOI: 10.23736/S2724-5683.22.06040-9


language: English

Transcatheter aortic valve implantation in patients with age ≤70 years: experience from two leading structural heart disease centers

Marco RUSSO 1 , Nicola CORCIONE 2, Antonio G. CAMMARDELLA 1, Federico RANOCCHI 1, Antonio LIO 1, Gugliemo SAITTO 1, Francesca NICOLÒ 1, Amedeo PERGOLINI 1, Vincenzo POLIZZI 1, Paolo FERRARO 3, Alberto MORELLO 2, Michele CIMMINO 2, Michele ALBANESE 3, Luisa NESTOLA 2, Giuseppe BIONDI-ZOCCAI 4, 5, Martino PEPE 6, Luca BARDI 2, Arturo GIORDANO 2, Francesco MUSUMECI 1

1 Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy; 2 Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Caserta, Italy; 3 Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Napoli, Italy; 4 Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; 5 Mediterranea Cardiocentro, Napoli, Italy; 6 Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari Aldo Moro, Bari, Italy


BACKGROUND: Transcatheter aortic valve implantation (TAVI) is emerging a an appealing management strategy for patients with severe aortic stenosis at intermediate, high or exceedingly high risk, but its risk-benefit profile in younger patients is less certain. We aimed at exploring the outlook of patients aged 70 years or less and undergoing TAVI at 2 high-volume Italian institituions.
METHODS: We retrospectively collected baseline, imaging, procedural and outcome features of patients with age ≤70 years in whom TAVI was attempted at participating centers between 2012 and 2021. Non-parametric tests and bootstrap resampling were used for inferential purposes.
RESULTS: A total of 39 patients were included, out of >3,000 screened with heart team involvement and >1,500 receiving TAVI. Most common or relevant indications for TAVI were reduced life expectancy (eg cardiogenic shock or severe left ventricular systolic dysfunction), chronic obstructive pulmonary disease, morbid obesity, active or recent extra-cardiac cancer, porcelain aorta, neurologic disability, cirrhosis, or prior surgical aortic valve replacement, as well as extreme cachexia, and Hutchinson-Gilford progeria. At least two contemporary high-risk features were present in most cases. Transapical access was used in 5 (12.8%) cases, and a sheathless approach in 15 (38.5%). A variety of devices were used, including both balloon- and selfexpandable devices. Clinical outcomes were satisfactory, despite the high risk profile, at both shortand mid-term, with no in-hospital death, and 5.1% (95% confidence interval 0-12.8%) mortality at a median follow-up of 15 months (minimum 1; maximum 85). Notably, no case of significant valve deterioration requiring reintervention occurred.
CONCLUSIONS: In carefully selected patients with 70 years or less of age and prohibitive risk for surgery or reduced life expectancy, TAVI represents a safe option with a favorable mid-term survival and low rate of adverse events.

KEY WORDS: Age; Aortic stenosis; Transcatheter aortic valve implantation; Transcatheter aortic valve replacement

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