Retrospective evulation of clinical, electrocardiographic and laboratory parameters of patients undergoing transcatheter aortic valve implantation in the cardiology department of Dokuz Eylul University Faculty of Medicine

The improvement in clinical outcomes after many studies ,the increase in the number of experienced operators, the results of long term survival of patients and the expansion of the indication range have accelerated the development of Transcatheter aortic valve implantation (TAVI) in the last ten years. The aim of our study is to retrospectively evaluate the clinical, electrocardiographic and laboratory findings obtained from our experience with TAVI performed with different bioprosthetic valves. A total of 441 symptomatic severe aortic stenosis patients were deemed appropriate for TAVI from those who were approved for TAVI as a result of the evaluation of the heart team, who applied to Dokuz Eylül University Hospital Department of Cardiology between 01.06.2012 - 31.05.2019 out of 459 patients. The lenght of intensive care and hospital follow-up, in-hospital events, pre- and post-procedure ECG and laboratory parameters, in-hospital and first-year mortality rates and associated predictors were examined. A total of 441 patients with severe aortic stenosis, including 243 women (55%), were included in the study. The average age of the patients was 77.7 ± 7.8 years, the median STS score was %3.5; mean Logistic EuroSCORE was %23.34 ±11.3 In the echocardiography performed before the procedure, the mean LVEF were 51.62 ± 13.67%; transaortic gradient was 48.06 ± 16.15 mmHg and aortic valve area was 0.62 ± 0.16 cm2. CoreValve 47.8%, Portico 39.9%, Edwards SAPIEN 11.6% and Direct Flow 0.7% bioprosthetic valve were implanted in of the patients. The median follow-up period in the coronary intensive care unit was four days, and the median hospital stay was 14 days. It was determined that LV functions of the patients improved after TAVI and increased more in the LVEF <40% patient group. Device success was 88.4% according to VARC-2 and 84.1% according to VARC-3.Vascular complications were seen with a rate of 10.9%. Vascular complications were less common in those with 0 blood type. Permanent pacemaker need was 10.7%. Acute cerebrovascular event developed in 2.1% of patients; contrast nephropathy developed in 9.1% and the need for hemodialysis developed in 1.4% of the patients. In-hospital mortality was 7%. Pre-TAVI serum albumin level (OR: 0.230; p=0.028), post-TAVI cerebrovascular event development (OR: 15.904; p=0.004) and post-TAVI contrast nephropathy (OR: 6.322; p=0.001) were found to be predictors of in-hospital mortality. All-cause first-year mortality was observed in 21.3% of the patients. Pre-TAVI serum albumin level (OR: 0.364; p=0.011) and pre-TAVI serum neutrophil/lymphocyte ratio (OR: 1.144; p=0.019) were found as predictors of first-year mortality. The median survival time according to the Kaplan Meier Curve was 53 months at the eight-year follow-up. Survival time was longer in women 61 months compared to men 40 months (P=0.024 Log Rank). The fifth-year survival rate is 46.5%, and the eighth-year survival rate is 26.2%. Our study is one of the studies with the largest patient population with eight-year follow-up, including single-center, in-hospital and first-year mortality predictors, in which our TAVI experiences are shared.