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Registry of Transcatheter Aortic-Valve Implantation in High-Risk Patients

  作者 Gilard, M; Eltchaninoff, H; Iung, B; Donzeau-Gouge, P; Chevreul, K; Fajadet, J; Leprince, P; Leguerrier, A; Lievre, M; Prat, A; Teiger, E; Lefevre, T; Himbert, D; Tchetche, D; Carrie, D; Albat, B; Cribier, A; Rioufol, G; Sudre, A; Blanchard, D; Collet, F; Dos Santos, P; Meneveau, N; Tirouvanziam, A; Caussin, C; Guyon, P; Boschat, J; Le Breton, H; Collart, F; Houel, R; Delpine, S; Souteyrand, G; Favereau, X; Ohlmann, P; Doisy, V; Grollier, G; Gommeaux, A; Claudel, JP; Bourlon, F; Bertrand, B; Van Belle, E; Laskar, M  
  选自 期刊  New England Journal of Medicine;  卷期  2012年366-18;  页码  1705-1715  
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[摘要]Background Transcatheter aortic-valve implantation (TAVI) is an emerging intervention for the treatment of high-risk patients with severe aortic stenosis and coexisting illnesses. We report the results of a prospective multicenter study of the French national transcatheter aortic-valve implantation registry, FRANCE 2. Methods All TAVIs performed in France, as listed in the FRANCE 2 registry, were prospectively included in the study. The primary end point was death from any cause. Results A total of 3195 patients were enrolled between January 2010 and October 2011 at 34 centers. The mean (+/- SD) age was 82.7 +/- 7.2 years; 49% of the patients were women. All patients were highly symptomatic and were at high surgical risk for aortic-valve replacement. Edwards SAPIEN and Medtronic CoreValve devices were implanted in 66.9% and 33.1% of patients, respectively. Approaches were either transarterial (transfemoral, 74.6%; subclavian, 5.8%; and other, 1.8%) or transapical (17.8%). The procedural success rate was 96.9%. Rates of death at 30 days and 1 year were 9.7% and 24.0%, respectively. At 1 year, the incidence of stroke was 4.1%, and the incidence of periprosthetic aortic regurgitation was 64.5%. In a multivariate model, a higher logistic risk score on the European System for Cardiac Operative Risk Evaluation (EuroSCORE), New York Heart Association functional class III or IV symptoms, the use of a transapical TAVI approach, and a higher amount of periprosthetic regurgitation were significantly associated with reduced survival. Conclusions This prospective registry study reflected real-life TAVI experience in high-risk elderly patients with aortic stenosis, in whom TAVI appeared to be a reasonable option. (Funded by Edwards Lifesciences and Medtronic.)

 
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