title: Causes of peri-operative mortality after transcatheter aortic valve implantation: a pooled analysis of 12 studies and 1223 patients.
abstract: BACKGROUND
  In order to improve technique and to prevent serious procedural complications during transcatheter aortic valve implantation (TAVI), it is crucial to identify the causes of death of patients undergoing this procedure.
  
  
  OBJECTIVE
  The objective of this study was to identify the causes of death during the procedure and at 1 month in patients with severe aortic stenosis undergoing TAVI.
  
  
  METHODS
  12 published studies with information about the causes of death in patients undergoing TAVI were selected. Overall, 1223 patients were included in these studies, and 249 deaths were reported (119 at 1 month and 130 at >1 month post-procedure). Mortality during the procedure and at 1 month was 2.3% and 9.7%, respectively. The proportion of cardiac deaths was higher at <1 month in comparison with >1 month (56% versus 34%, respectively; p = 0.001). At 1 month, the most frequent causes of death were cardiac failure/multi-organ failure (24%), sudden death/cardiac arrest (17%), vascular and bleeding complications (17%), stroke (11%), sepsis (11%), and cardiac tamponade (10%). During the procedure, the most frequent causes of death were cardiac tamponade (39%), cardiac failure (21%), cardiac arrest (18%), and vascular and/or bleeding complications (18%). In patients treated with the CoreValve system (Medtronic, Minneapolis, Minnesota) versus those treated with Edwards valves (Cribier-Edwards, Edwards-SAPIEN or SAPIEN XT valve, Edward Lifesciences, Irvine, California), deaths at 1 month due to vascular and bleeding complications were less frequent (3% versus 22%, respectively; p = 0.019), but those due to cardiac tamponade (26% versus 6%, respectively; p = 0.019), and because of aortic regurgitation (10% versus 0%, respectively; p = 0.03) were more frequent.
  
  
  CONCLUSIONS
  In this pooled analysis, mortality at 1 month after TAVI was 9.7%. The causes of death were widely variable, and of both cardiac and non-cardiac origin. There were some important differences between both devices in the cause of mortality.
authors.affiliation: University Hospital La Paz, Interventional Cardiology (Diagonal, 1), Paseo La Castellana, 261. Diagonal 1, Madrid, 28046, Spain. raulmorenog@terra.es.
authors.forename: Raul
authors.initials: R
authors.lastname: Moreno
authors.forename: Luis
authors.initials: L
authors.lastname: Calvo
authors.forename: Pablo
authors.initials: P
authors.lastname: Salinas
authors.forename: David
authors.initials: D
authors.lastname: Dobarro
authors.forename: Jimenez Valero
authors.initials: JV
authors.lastname: Santiago
authors.forename: Angel
authors.initials: A
authors.lastname: Sanchez-Recalde
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.forename: Luis
authors.initials: L
authors.lastname: Riera
authors.forename: Isidro
authors.initials: I
authors.lastname: Moreno-Gomez
authors.forename: Jose
authors.initials: J
authors.lastname: Mesa
authors.forename: Ignacio
authors.initials: I
authors.lastname: Plaza
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez-Sendon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000150:complications; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality*; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D059035:Perioperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome