- Fragestellung und Ziele: In three separate analyses, we aimed to assess the outcomes of TAVR in patients with BMI ≥ 25, in patients with reduced functional capacity, and in patients with chronic renal failure who underwent TAVR without the use of contrast medium.
- Methodik: For these analyses, we retrospectively evaluated data from TAVR patients at the Central Hospital Bad Berka, Germany. All decisions regarding the method of TAVR, the choice of prosthesis, and the access route were made by the institutional heart-team, which is comprised of cardiologists, cardiac surgeons, and anesthesiologists.
- Ergebnisse: In the first study, we included 25 patients with glomerular filtration rate (GFR) <30 mL/min/1.73 m2 who underwent TF-TAVR procedure with the Edwards Sapien balloon-expandable bio prostheses but without the use of contrast between September 2017 and September 2018. The results obtained were compared with data acquired from 73 matched patients (the control group), who underwent TF-TAVR with Edwards Sapien balloon-expandable bio prostheses with the standard technique using CM. We showed that TF-TAVR without the use of CM can be considered a safe and reproducible alternative technique. In the second study, we investigated the influence of BMI on the 1-year outcomes after TF-TAVR in 1609 high- and intermediate-risk TAVR patients who underwent the procedure between March 2014 and March 2018. BMI ≥ 25 kg/m2 was independently associated with lower 1 year mortality after TF-TAVR. The rate of vascular complications was higher in patients with BMI ≥ 25 kg/m2, which indicates the need for optimization of puncture technique and careful selection of closure devices in this group of patients. In the third study, we investigated the influence of functional impairment, as assessed by the BI, on outcomes 3-months after TF-TAVR. The procedures were performed, under general anesthesia, between January 2017 and January 2018 in 336 patients.