Effectiveness of transcatheter aortic valve replacement for elderly severe aortic stenosis: a short and mid-term follow-up analysis

Objective To explore the immediate clinical effectiveness of transcatheter aortic valve replacement for severe aortic stenosis(AS) in elderly patients, and to evaluate short-and mid-term follow-up results.Methods A total of 12 patients with severe calcified AS who were admitted to the Affiliated Hospital of Xuzhou Medical University from April 2018 to February 2022 were enrolled. After rigorous preoperative evaluation, domestic aortic valves were selected for transcatheter aortic valve replacement(TAVR). After surgery, the cardiac function and adverse events were regularly recorded.Results All the patients successfully completed TAVR, including five men and seven women, with an median age of 77 years. The American College of Thoracic Surgeons(STS) score was(5.05±2.75) %. The operation time was(187.91±36.65) min. The difference of postoperative aortic valve cross-valve pressure significantly decreased(P＜0.01). There were seven cases of perioperative slight paravalvular leakage, one case of cardiogenic shock, one case of acute heart failure, two cases of complete left bundle branch blocks, one case of interval femoral artery hematoma at puncture, and one femoral arteriovenous fistula, without middle valve implantation. Two patients underwent percutaneous coronary intervention before TAVR, including one case of drug balloon dilation and one case of stent implantation. After the levels of postoperative N-terminal pro-B-type natriuretic peptide(NT-proBNP) were reduced, the aortic valve opening increased, the artificial valve opening and closing function became normal, and the order difference of average transvalve pressures significantly decreased, and the left ventricular systolic function improved. The median follow-up visits were 29 months. One patient was diagnosed with subacute infective endocarditis two months after operation and died 20 days after diagnosis. No major adverse cardiac events such as myocardial infarction occurred in other patients. The score of the Kansas City Quality of Life scale(KCCQ) remarkably increased(P＜0.01). The related clinical symptoms and the quality of life were improved.Conclusions Transcatheter aortic valve replacement in elderly patients with severe AS can significantly improve hemodynamic parameters and cardiac function. The short-and medium-term follow-up visits show that the clinical symptoms and quality of life of the patients are improved, which has a wide range of clinical application prospects.