Transcatheter aortic valve implantation applied in patients comparison of balon expandable and self expandable lids in terms of demographic and complications and evaluation of complication predictors

Aim: TAVR provides an alternative option to surgery for patients with symptomatic severe aortic stenosis, with a life expectancy of more than 1 year, for which aortic valve is required. The most commonly used caps for clinical use currently include Balloon expandable Edwars SAPIEN and Self expandable CorValveRevalving closures. The aim of our study is to compare Balloon expandable caps and self expandable caps used in TAVR procedures applied in our center and to determine the predictors of complications. Materials and Methods: In our study, TAVR procedure was performed on 96 patients who had symptomatic severe AD between 01.04.2013-01.01.2018 and accepted as high open surgical risk. The data of these patients were screened retrospectively. Basically, the conditions for inclusion are; the presence of symptoms in patients, aortic valve area <1 cm2, mean aortic valve gradient> 40 mmHg, STS score ≥8 and EuroSCORE II ≥8, functional capacity ≥II or AVR for surgical contraindications was taken. The reasons why our patients are not admitted to AVR are generally the reasons that increase the surgical risk such as advanced age, malignancy, hemodynamic disorder, chronic obstructive pulmonary disease, renal failure, additional valve pathologies and left heart dysfunctions. Clinical, laboratory and echocardiographic data of the patients who underwent TAVR were analyzed retrospectively. Results: The study included 96 patients with severe aortic stenosis. Of the 96 patients, 37.5% (36) were male and 62.5% (60) were female. The mean age was 78.5 ± 6.6 and the median value was 79 (min: 62, max: 94). Median STS score of the patients was 17.7 (13.0-23.3), EuroSCORE II 10.7 (7.1-20.3). Echocardiographic imaging before the procedure was detected average maximum TAG was 79.1 ± 20.2 mmHG, average mean TAG 48.7 ± 12.8 mmHG and aortic valve area (ACA) was 0.72 ± 0.13 cm2 on average. Of the implanted caps, 41 (42.8%) were Edwars SAPIEN and 55 (57.2%) were Core Valve Medtronic. The mean hospitalization period was 4.88 ± 4.4 days. Complications occurred in 31 (32.3%) patients. These complications were observed respectively, tamponade in 7 patients, av complete block in 9 patients, femoral artery injury in 4 patients, infection in 2 patients, malignant arrhythmia in 4 patients, coronary embolism in 1 patient, iliac artery injury in 2 patients and svo in 2 patients. Of the patients who had complications, 18 (58%) had Edwars SAPIEN and 13 (42%) had a Core Valve Medtronic valve insertion and a statistically significant increase was observed in patients with balloon expandable valve(p=0.036). 12 (12.5%) of the patients underwent death in the periprocedural period. From the laboratory findings at the time of admission in patients with complications hemoglobin and hematocrit values were found to be significantly lower than the patients who did not develop complications (p values were found to be 0.020 and 0.002, respectively). CRP (c-reactive protein) was found to be high at the time of admission in complication-developing patient compared to those who did not develop any complication(p=0.034). In the initial echocardiographic findings of patients with and without complication, aortic valve area was significantly narrower in the group with complications (0.67 ± 0.17, 0.75 ± 0.10, p: 0.007, respectively). Initial echocardiographic findings were significantly higher max and mean gradient in the group with complications (86.9 ± 23.7 to 75.3 ± 17.3 p= 0.008 and 54.6 ± 15.6 to 45.98 ± 10.1 p= 0.002 respectively). Binary logistic regression analysis revealed that balloon expandable valve insertion was 24%, hemoglobin value decreased by 1 unit 36%, hematocrit value decreased by 1 unit 1.5 times and C-reactive protein value increased by 1 unit 83% increases the risk of complication. Conclusion: Total complication rate was higher in patients with balloon expandable valve but AV complete block was more common in patients with self expandable valve. Laboratory findings during hospital admission, hemoglobin and hematocrit values were significantly lower and CRP (c-reactive protein) was found to be higher in patients with complications. The echocardiographic findings at admission, aortic valve area was found to be narrower and maximum and mean gradient was higher in patients with complications. Key words: TAVR, balloon expandable, self expandable, hematocrit, hemoglobin, aortic valve area, mean gradient, maximum gradient, CRP (c-reactive protein)