title: Transapical aortic valve implantation: analysis of risk factors and learning experience in 299 patients.
abstract: BACKGROUND
  Transapical aortic valve implantation has evolved to a reproducible therapeutic option for high-risk patients. The aim of the present study was to evaluate our learning experience over 4 years and to analyze outcome-related risk factors.
  
  
  RESULTS
  A total of 299 patients who received transapical aortic valve implantation between February 2006 and January 2010 with the Edwards SAPIEN transcatheter prosthesis were analyzed according to early experience (EE; patients 1 to 150) and recent experience (RE; patients 151 to 299). Patients consistently demonstrated high risk scores, and major perioperative parameters were comparable between the 2 groups. RE patients had a significantly higher logistic EuroSCORE (RE 33.2 ± 17.2, EE 29.4 ± 14; P=0.039) but a significantly lower STS (Society of Thoracic Surgeons) score (RE 11.4 ± 7.5, EE 13.5 ± 7.8; P=0.019). Use of contrast dye (EE 104 ± 78 mL, RE 93 ± 46 mL) and the need to perform a balloon redilation were significantly reduced in the RE group. Thirty-day mortality decreased from 11.3% to 6.0%, and 1-year mortality improved significantly from 30.7% (EE) to 21.5% in the RE patients (P=0.047). Multivariate logistic regression analysis revealed reduced vital capacity (<70%) and concomitant preoperative mitral regurgitation >1+ as the only independent predictors of 30-day mortality. Classic variables such as age, logistic EuroSCORE >30%, and STS score >15% failed to predict mortality.
  
  
  CONCLUSIONS
  Recent results with transapical aortic valve implantation indicate a progressive improvement in outcomes despite an unchanged patient risk profile, which reflects a significant learning curve that includes a better understanding of optimal patient selection. Classic surgical risk factors fail to predict outcome, which indicates the need for new transapical aortic valve implantation-specific risk scores.
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Leipzig, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kempfert
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.forename: David
authors.initials: D
authors.lastname: Holzhey
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Arnaud
authors.initials: A
authors.lastname: van Linden
authors.forename: Johannes
authors.initials: J
authors.lastname: Blumenstein
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome