title: Transcatheter aortic valve implantation in patients with severe symptomatic aortic valve stenosis-predictors of mortality and poor treatment response.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has emerged as an alternative technique in patients with severe symptomatic aortic valve stenosis. However, a number of patients have no benefit after implantation. This prospective study attempted to identify predictors of poor treatment response.
  
  
  METHODS
  From June 2008 to September 2010, consecutive patients with symptomatic severe aortic valve stenosis and high surgical risk were submitted to TAVI with the CoreValve prosthesis (Medtronic, Minneapolis, MN). The primary end point was all-cause mortality at 6 months. Secondary end point (poor treatment response) was defined as no improvement of symptoms assessed with the New York Heart Association class 6 months after TAVI.
  
  
  RESULTS
  A total of 145 patients (mean age 79.1 ± 6.4 years, mean logistic EuroSCORE 21% ± 16.2%) were included. During the follow-up period, 23 (15.9%) patients died. Independent predictors of all-cause mortality were as follows: aortic mean gradient ≤40 mm Hg (odds ratio [OR] 3.93), moderate and severe tricuspid valve regurgitation (OR 4.50), and moderate and severe postprocedural aortic valve regurgitation (OR 4.26). In 122 surviving patients, 25 patients (20%) showed no improvement in symptoms. Independent predictors of poor treatment response were severe mitral valve regurgitation (OR 7.42) and moderate and severe postprocedural aortic valve regurgitation (OR 10.1).
  
  
  CONCLUSIONS
  Cardiac comorbidities (low-gradient aortic stenosis, tricuspidal valve regurgitation) are associated with all-cause mortality, whereas mitral valve regurgitation is a risk factor for poor treatment response after TAVI. Postprocedural aortic valve regurgitation is a strong predictor of both-mortality and poor treatment response.
authors.affiliation: Cardiology and Angiology, BG University–Hospital Bergmannsheil, Bochum, Germany. michael_gotzmann@web.de
authors.forename: Michael
authors.initials: M
authors.lastname: Gotzmann
authors.forename: Azem
authors.initials: A
authors.lastname: Pljakic
authors.forename: Waldemar
authors.initials: W
authors.lastname: Bojara
authors.forename: Michael
authors.initials: M
authors.lastname: Lindstaedt
authors.forename: Aydan
authors.initials: A
authors.lastname: Ewers
authors.forename: Alfried
authors.initials: A
authors.lastname: Germing
authors.forename: Andreas
authors.initials: A
authors.lastname: Mügge
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods* / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends