Zusammenfassung
ZIEL: Komorbiditäten stellen beträchtliche Herausforderungen an Screening, Selektion und Nachbeobachtung vor bzw. nach transkutaner Aortenklappenimplantation (TAVI) ebenso wie an die Prozedur selbst. Ziel der vorliegenden Studie war es, neben klinischen Endpunktdaten die Raten kardialer und nicht-kardialer Rehospitalisierungen der ersten 50 Patienten aus einem monozentrischen TAVI-Programm zu untersuchen. METHODEN UND RESULTATE: TAVI erfolgten mittels des transfemoralen retrograden CoreValve Systems. Die prozedurale Erfolgsrate lag bei 94 %; die intraprozedurale Mortalität betrug 2 %. Nach 30 Tagen waren 82 % der Patienten frei von einem kombinierten Sicherheits-Endpunkt, und nach sechs Monaten waren 76.1 % frei von einem kombinierten Effektivitäts-Endpunkt (modifizierte Kriterien des Valve Academic Research Consortium). Bis sechs Monate nach TAVI kam es unter den überlebenden Patienten bei 10,3 % aus kardialer Ursache und bei 43.6 % aus nicht-kardialer Ursache zu mindestens einer Rehospitalisierung. Die nicht-kardialen Ursachen einer Rehospitalisierung zeigten dabei eine breite Streuung über verschiedene medizinische Fachdisziplinen, entsprechend der hohen Prävalenz von Komorbiditäten. Anschließend bis zu einem vordefinierten Stichzeitpunkt (mittlere Nachbeobachtungszeit 9.9 Monate) fiel die Wahrscheinlichkeit einer Rehospitalisierung um die Hälfte (1.54 vs. 0.74 Spitalstage pro Patient pro Monat), bedingt durch eine Abnahme der nicht-kardialen Rehospitalisierungen. Der Karnofsky-Score vor und nach TAVI zeigte eine signifikante und anhaltende Besserung der Alltagsleistungsfähigkeit mittels retrospektiver Erhebung zum Stichzeitpunkt. SCHLUSSFOLGERUNG: Die Ergebnisse der vorliegenden Studie deuten darauf hin, dass die hohe Prävalenz von Komorbiditäten bei Hochrisiko-Patienten in einer hohen Rate an nicht kardialen Rehospitalisierungen während der ersten 6 Monate nach TAVI resultiert. Dennoch scheint die Verbesserung der Alltagsleistung infolge einer TAVI aus Sicht der Patienten substanziell zu sein.
Summary
AIMS: Comorbidities pose a major challenge to screening, selection and follow-up of transcatheter aortic valve implantation (TAVI) patients as well as to the procedure itself. The aim of the present study was to assess cardiac and non-cardiac readmission rates besides clinical endpoint data in the first 50 patients of a single center TAVI programme. METHODS AND RESULTS: TAVI was performed using the transfemoral CoreValve system. Procedural success rate was 94%; intraprocedural mortality was 2%. 82% of the patients remained free of a combined safety endpoint at 30 days, and 76.1% remained free of a combined efficacy endpoint at six months (modified criteria of the Valve Academic Research Consortium). At six months, among all surviving patients, 10.3% had experienced readmissions for cardiac causes, and 43.6% had experienced readmissions for non-cardiac causes. Causes of non-cardiac readmissions showed a wide distribution over various medical disciplines, reflecting the high rate of comorbidities. Beyond six months until a predefined reference date (mean follow up 9.9 months), the probability of hospitalization fell by half (1.54 vs. 0.74 hospital days per patient per month), driven by a decrease of non-cardiac readmissions. Karnofsky score before and after TAVI yielded a significant and sustained improvement of performance status, as assessed retrospectively at reference date. CONCLUSION: The findings of the present study suggest that the high prevalence of comorbidities in high-risk TAVI patients results in a high rate of non-cardiac rehospitalizations during the first 6 months of follow-up. Despite this fact, improvement of global everyday performance following TAVI as perceived by the patients seems to be substantial.
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Hammerer, M., Schuler, J., Altenberger, J. et al. Rehospitalization rates after transcatheter aortic valve implantation. Wien Klin Wochenschr 124, 45–52 (2012). https://doi.org/10.1007/s00508-011-0075-z
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DOI: https://doi.org/10.1007/s00508-011-0075-z