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Dr. David Holmes,
Prof. Carlo Di Mario,
Presenter | see Discussant report
Carlo Di Mario
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The Transcatheter Valve Treatment Sentinel Pilot Registry is a prospective independent consecutive collection of individual patient data entered into a web-based case record form (CRF) or transferred from compatible national registries. A total of 4571 patients underwent transcatheter aortic valve implantation (TAVI) between January 2011 and May 2012 in 137 centres of 10 European countries. Average age was 81.4±7.1 years with equal representation of the two sexes. Patients ≤80 had greater incidence of diabetes, COPD, extracardiac arteriopathy, dialysis, previous myocardial infarction, previous cardiac surgery or PCI, previous aortic valve replacement (AVR), LVEF <30%. Logistic Euroscore (20.2±13.3), access site (femoral approach preferred in 74.2%), type of anesthesia (only local used in 39.0% of transfemoral procedures) and duration of hospital stay (9.3±8.1 days) showed wide variations among the participating countries. In-hospital mortality (7.4%), stroke (1.8%), myocardial infarction (0.9%), major vascular complications (3.1%) were similar in the balloon expandable SapienXT and the self-expandable CoreValve, p=0.15. Mortality was lower in trans-femoral (5.9%) than in trans-apical (12.8%) and other access routes (9.7%), p<0.01. Advanced age, high logistic Euroscore, pre-procedural ≥grade2 mitral regurgitation, deployment failure predicted higher mortality at multivariate analysis. A permanent pace-maker was required in 23.4% of CoreValves and 6.0% of SapienXT valves, p<0.01. Echocardiography showed postprocedural aortic regurgitation grade 2 in 7.7% and grade 3 in 1.3% (Grade≥2 11.4% CoreValve and 6.7% SapienXT, p<0.01). This truly contemporary TAVI registry using the most recent valve types and delivery catheters suggests lower mortality, stroke and vascular complications than historical studies and registries.
Discussant | see Presenter abstract
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Clinical Trial & Registry Update III: Updates on Atrial Fibrillation and Valves
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