title: Transcatheter aortic valve implantation decreases the rate of unoperated aortic stenosis.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) is the standard treatment for severe, symptomatic aortic stenosis (AS). However, many patients are not referred for surgery and fewer undergo AVR. Transcatheter aortic valve implantation (TAVI) has emerged as a solution for high-risk AS patients. We sought to measure the impact of TAVI on the undertreatment of AS.
  
  
  METHODS
  Patients with AS were identified by retrospective medical record review and evaluation of echocardiograms were performed in a single-center tertiary-care institution. A total of 179, 183, 214, and 265 patients had AS in 2006, 2007, 2008, and 2009, respectively, with the introduction of TAVI occurring in 2008 and continuing through 2009. The primary endpoints were the rates of unoperated AS and surgical referral.
  
  
  RESULTS
  The rates of unoperated AS were 50.6% before TAVI and 40.7% after TAVI (p = 0.002). Referral rates to surgery were 63.6% before TAVI and 74.1% after TAVI (p = 0.003). Reasons for nonreferral were patient-family decision, perceived high operative risk, and the presence of comorbidities. Operative mortality was 3.7% and not statistically significant different between years. Three-year patient survival was 82.5% in the AVS group and 43.9% in the UNOP group (p < 0.001).
  
  
  CONCLUSIONS
  The introduction of TAVI was associated with an increase in surgical referrals and a decrease in the rate of unoperated AS. This positive impact was due to increases in both TAVI and AVR volume. Increased volume was not associated with worse patient survival. A significant population of patients with AS are still treated medically.
authors.affiliation: Division of Cardiac Surgery, Northwestern University, Feinberg School of Medicine, Bluhm Cardiovascular Institute at Northwestern Memorial Hospital, Chicago, IL, USA. malaisrie@northwestern.edu
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.forename: Eric
authors.initials: E
authors.lastname: Tuday
authors.forename: Brittany
authors.initials: B
authors.lastname: Lapin
authors.forename: Edward
authors.initials: E
authors.lastname: Wang
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Edwin C
authors.initials: EC
authors.lastname: McGee
authors.forename: Charles
authors.initials: C
authors.lastname: Davidson
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D000075202:Contraindications; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014463:Ultrasonography