Short and mid term results, efficiency and reliability of Akdeniz University Medical Faculty Hospital transcatheter aortic valve implantation

Aortic stenosis is a chronic, progressive disease that causes narrowing of the left ventricular outflow tract. The most common cause of aortic stenosis aetiology in advanced age is calcific, degenerative aortic stenosis. The appearance of symptoms is a critical point in the course of the disease and mortality is quite high after symptoms develop. Conventional treatment of aortic stenosis is surgically aortic valve replacement. The advanced age and accompanying comorbidities increase the risk of surgical mortality and morbidity. Transcatheter aortic valve implantation procedure is used in the treatment of patients with high risk of surgical mortality and morbidity. The aim of our study is to evaluate the results of transcatheter aortic valve implantation in terms of efficacy and safety and contribute to the improvement of the treatment with the results. The primary outcome point of our study was defined as perioperative mortality, secondary endpoints were defined as the major adverse cardiovascular and cerebrovascular events that occurred in the 6-month period and the need for permanent cardiac pacemaker after the procedure. In our study, 89 patients who underwent transcatheter aortic valve implantation between 2014 and 2017 were retrospectively analyzed. Perioperative mortality developed in 10 patients (11,2%). In patients who had perioperative mortality, the neutrophil-lymphocyte ratio was significantly higher in the blood tests before the procedure than in the patients without mortality. In patients with perioperative mortality, postoperative hemoglobin levels were significantly lower and creatinine levels at 48 hours were higher. In these patients, post-procedural transfusion and need of permanent cardiac pacemaker were significantly higher than patients without mortality. Out of the 6 patients who had permanent cardiac pacemaker before the procedure, after the procedure permanent pacemakers were implanted 24(%28,9) of 83 patients. Patients with right branch block in the electrocardiography before the procedure, with a smaller tomographic aortic valve area and anulus diameter, had a higher need for permanent pacemaker after the procedure. Major adverse cardiovascular and cerebrovascular events occurred within 6 months in 21 (26.5%) of 79 patients who surviving after the perioperative period. Hospitalized with decompensated heart failure was the most common cardiovascular and cerebrovascular event. Preoperative leukocyte, neutrophil and C-reactive protein levels, neutrophil-lymphocyte ratio and postoperative leukocyte and C-reactive protein levels were significantly higher in the patients with cardiovascular events. Patients who develop cardiovascular and cerebrovascular events are in need of more transfusions but have not achieved statistical significance. In the regression analyzes, need for permanent cardiac pacemaker after surgery was an independent risk factor for perioperative mortality. Requirement of transfusion has been an independent risk factor for both perioperative mortality and major adverse cardiovascular and cerebrovascular events during siz months. Surgical risk scores did not predict either perioperative mortality nor 6-month cardiovascular and cerebrovascular events. We think that the combined use of these risk scores with additional parameters such as C-reactive protein, neutrophil-lymphocyte ratio will predict both mortality and cardiovascular and cerebrovascular events more strongly. As a result, transcatheter aortic valve implantation is an appropriate treatment option with low mortality risk in patients who can not undergo surgery because of high risk.