title: How many patients with severe symptomatic aortic stenosis excluded for cardiac surgery are eligible for transcatheter heart valve implantation?
abstract: OBJECTIVE
  We sought to assess what proportion of patients with severe symptomatic aortic stenosis who are excluded from cardiac surgery are eligible for transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Between July 2007 and December 2008, 98 patients with severe symptomatic aortic stenosis judged inoperable were referred to our institution for percutaneous aortic balloon valvuloplasty (PABV). They entered a screening for TAVI with the CoreValve Revalving System or the Edwards-Sapien valve, comprising general clinical evaluation, echocardiogram, coronary angiography, angiography and angio-CT scan of thoracic aorta and ilio-femoral axes.
  
  
  RESULTS
  Mean patients' age was 82 +/- 7 years; the vast majority presented relevant comorbidities. Mortality risk predicted by the logistic European System for Cardiac Operative Risk Evaluation was on average 25.3 +/- 14.5%. Overall, 45 (45.9%) patients met the criteria for TAVI: 29.6% for percutaneous transfemoral access, 6.1% for trans-subclavian and 10.2% for transapical approaches. Reason for exclusion was severe noncardiac comorbidity in around half of the cases. PABV allowed re-classification of several patients with very poor left ejection fraction and severe mitral regurgitation. Among the 39 patients undergoing TAVI after the screening, in-hospital mortality was 3.7% for transfemoral and 0 for trans-subclavian and transapical approaches.
  
  
  CONCLUSIONS
  TAVI represents a viable therapeutic option for elderly patients with severe symptomatic aortic stenosis who are not candidates for surgical aortic valve replacement. However, presently less than half of them actually fulfil the criteria for these procedures.
authors.affiliation: Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy. francescosaia@hotmail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Cinzia
authors.initials: C
authors.lastname: Marrozzini
authors.forename: Gianni
authors.initials: G
authors.lastname: Dall'Ara
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Russo
authors.forename: Sofia
authors.initials: S
authors.lastname: Martìn-Suàrez
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.forename: Paolo
authors.initials: P
authors.lastname: Ortolani
authors.forename: Tullio
authors.initials: T
authors.lastname: Palmerini
authors.forename: Nevio
authors.initials: N
authors.lastname: Taglieri
authors.forename: Barbara
authors.initials: B
authors.lastname: Bordoni
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pilato
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Angelo
authors.initials: A
authors.lastname: Branzi
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D004608:Eligibility Determination; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome