NUK - logo
E-viri
Recenzirano Odprti dostop
  • Kalra, Sundeep S; Firoozi, Sami; Yeh, James; Blackman, Daniel J; Rashid, Shabnam; Davies, Simon; Moat, Neil; Dalby, Miles; Kabir, Tito; Khogali, Saib S; Anderson, Richard A; Groves, Peter H; Mylotte, Darren; Hildick-Smith, David; Rampat, Rajiv; Kovac, Jan; Gunarathne, Ashan; Laborde, Jean-Claude; Brecker, Stephen J

    JACC. Cardiovascular interventions, 02/2017, Letnik: 10, Številka: 3
    Journal Article

    The authors present the UK and Irish real-world learning curve experience of the Evolut R transcatheter heart valve. The Evolut R is a self-expanding, repositionable, and fully recapturable second-generation transcatheter heart valve with several novel design features to improve outcomes and reduce complications. Clinical, procedural, and 30-day outcome data were prospectively collected for the first 264 patients to receive the Evolut R valve in the United Kingdom and Ireland. A total of 264 consecutive Evolut R implantations were performed across 9 centers. The mean age was 81.1 ± 7.8 years, and the mean logistic European System for Cardiac Operative Risk Evaluation score was 19.9 ± 13.7%. Procedural indications included aortic stenosis (72.0%), mixed aortic valve disease (17.4%), and failing aortic valve bioprostheses (10.6%). Conscious sedation was used in 39.8% of patients and transfemoral access in 93.6%. The procedural success rate was 91.3%, and paravalvular leak immediately after implantation was mild or less in 92.3%. Major complications were rare: cardiac tamponade in 0.4%, conversion to sternotomy in 0.8%, annular rupture in 0.0%, coronary occlusion in 0.8%, major vascular in 5.3%, acute kidney injury in 6.1%, new permanent pacemaker implantation in 14.7%, and procedure-related death in 0.0%. At 30-day follow-up, survival was 97.7%, paravalvular leak was mild or less in 92.3%, and the stroke rate was 3.8%. This registry represents the largest published real-world experience of the Evolut R valve. The procedural success rate was high and safety was excellent, comparable with previous studies of the Evolut R valve and other second-generation devices. The low rate of complications represents an improvement on first-generation devices.