부산대학교 도서관

BACKGROUND:: Transcatheter valve replacement (TVR) has become an effective solution for high risk patients, especially for those with valve prosthesis dysfunction.We report our ten year experience with early and late results. METHODS:: From November 2008 to May 2018,131 patients underwent surgical TVR in our center.All patients have been preoperatevely evaluated by the Heart team.Main comorbidities were: peripheral vascular disease in 51.1%, renal failure in 42% and pulmonary disease in 26%.There were 24.4% porcelain aorta and 27.5% of redo.Different prosthesis have been used: Medtronic Corevalve, Edwards Sapien, Jenavalve and Acurate symetis.There were 113 aortic, 15 mitral, 3 tricuspidalic valve disease treated respectively.Main surgical accesses were transapical in 93, transaortic in 31, left subclavian in 5 and full sternotomy in 2 patients. RESULTS:: Mean age was 81.1 ± 7.1, mean Euroscore was 9.9 ± 2.2 and STS score was 6.7 ± 5.4%.Overall early mortality was 6.1%.The global experience was divided into three periods as follow 2008–2012, 2013–2015 and 2016–2018 with a mortality rate of 10.4%, 7.3%, and 0% respectively.The only risk-factor for mortality was full sternotomy conversion (p = 0.001; OR = 60.5; CI[4.5;671.6]), necessary in 4 patients.The mean follow up time was 23.96 ± 26.28 months. Overall survival at 1 year, 3 years and 5 years was 84.2%, 61% and 41.6% respectively.Preoperative renal failure was risk factor for mortality at follow-up(p = 0.026;HR = 2.02;CI[1.09;3.75]). CONCLUSIONS:: Surgical TVR confirmed to be an effective solution for high risk patients, with satisfactory results in terms of mortality and postoperative outcome. With the increase in experience, mortality rate progressively decreased.