title: Incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis.
abstract: BACKGROUND
  There is a lack of information on the incidence and predictors of early mortality at 30 days and late mortality between 30 days and 1 year after transcatheter aortic valve implantation (TAVI) with the self-expanding CoreValve Revalving prosthesis.
  
  
  RESULTS
  A total of 663 consecutive patients (mean age 81.0 ± 7.3 years) underwent TAVI with the third generation 18-Fr CoreValve device in 14 centers. Procedural success and intraprocedural mortality were 98% and 0.9%, respectively. The cumulative incidences of mortality were 5.4% at 30 days, 12.2% at 6 months, and 15.0% at 1 year. The incidence density of mortality was 12.3 per 100 person-year of observation. Clinical and hemodynamic benefits observed acutely after TAVI were sustained at 1 year. Paravalvular leakages were trace to mild in the majority of cases. Conversion to open heart surgery (odds ratio [OR] 38.68), cardiac tamponade (OR 10.97), major access site complications (OR 8.47), left ventricular ejection fraction <40% (OR 3.51), prior balloon valvuloplasty (OR 2.87), and diabetes mellitus (OR 2.66) were independent predictors of mortality at 30 days, whereas prior stroke (hazard ratio [HR] 5.47), postprocedural paravalvular leak ≥ 2+ (HR 3.79), prior acute pulmonary edema (HR 2.70), and chronic kidney disease (HR 2.53) were independent predictors of mortality between 30 days and 1 year.
  
  
  CONCLUSIONS
  Benefit of TAVI with the CoreValve Revalving System is maintained over time up to 1 year, with acceptable mortality rates at various time points. Although procedural complications are strongly associated with early mortality at 30 days, comorbidities and postprocedural paravalvular aortic regurgitation ≥ 2+ mainly impact late outcomes between 30 days and 1 year.
authors.affiliation: Cardiology Department, Ferrarotto Hospital, University of Catania, Catania, Italy. dcapodanno@gmail.com
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Gennaro
authors.initials: G
authors.lastname: Santoro
authors.forename: Silvio
authors.initials: S
authors.lastname: Klugmann
authors.forename: Francesco
authors.initials: F
authors.lastname: Bedogni
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Antonio
authors.initials: A
authors.lastname: Marzocchi
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Poli
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D011237:Predictive Value of Tests; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors