title: Transcatheter aortic valve implantation: 3-year outcomes of self-expanding CoreValve prosthesis.
abstract: OBJECTIVE
  The paucity of evidences about the long-term durability of currently available transcatheter prostheses is one of the main issues of transcatheter aortic valve implantation (TAVI). We sought to assess 3-year clinical and echocardiographic outcomes of patients undergoing TAVI with the third generation CoreValve prosthesis (Medtronic Incorporation, MN, USA).
  
  
  RESULTS
  From the Italian CoreValve registry, 181 who underwent TAVI from June 2007 to August 2008 and eligible for 3-year follow-up were analysed. All outcomes were defined according to the Valve Academic Research Consortium. All-cause mortality at 1, 2, and 3 years was 23.6, 30.3, and 34.8%, respectively. Cardiovascular death at 1, 2, and 3 years was 11.2, 12.1, and 13.5%, respectively. The actuarial survival free from a composite of death, major stroke, myocardial infarction, and life-threatening bleeding was 69.6% at 1 year, 63.5% at 2 years, and 59.7% at 3 years. Patients with renal insufficiency had a higher mortality at 3-year follow-up (49.0 vs. 29.2%, P = 0.007); moreover, patients experiencing post-procedural major or life-threatening bleeding had a higher rate of mortality already seen at 30 days (21.6 vs. 2.8%; P < 0.001) and this result was sustained at 3-year follow-up (62.2 vs. 27.7%; P < 0.001). Mean pressure gradients decreased from 52.2 ± 18.1 mmHg (pre-TAVI) to 10.3 ± 3.1 mmHg (1-year post-TAVI) (P < 0.001); aortic valve area increased from 0.6 ± 0.2 cm(2) (pre-TAVI) to 1.8 ± 0.4 cm(2) (1-year post-TAVI); these results remained stable over the 3 years of follow-up. Paravalvular leak was observed in the majority of patients. There were no cases of progression to moderate or severe regurgitation. No cases of structural valve deterioration were observed.
  
  
  CONCLUSIONS
  This multicentre study demonstrates that TAVI with the 18-Fr CoreValve ReValving System is associated with sustained clinical and functional cardiovascular benefits in high-risk patients with symptomatic aortic stenosis up to 3-year follow-up. Non-cardiac causes accounted for the majority of deaths at follow-up.
authors.affiliation: Interventional Structural and Congenital Heart Disease Programme, Invasive Cardiology Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy. gpussia@hotmail.com
authors.forename: Gian Paolo
authors.initials: GP
authors.lastname: Ussia
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.forename: Federica
authors.initials: F
authors.lastname: Ettori
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
authors.forename: Roberto
authors.initials: R
authors.lastname: Violini
authors.forename: Angelo
authors.initials: A
authors.lastname: Ramondo
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: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.forename: Claudia
authors.initials: C
authors.lastname: Fiorina
authors.forename: Federico
authors.initials: F
authors.lastname: De Marco
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Emanuela
authors.initials: E
authors.lastname: de Cillis
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D019106:Postoperative Hemorrhage / Q000401:mortality; D011446:Prospective Studies; D011474:Prosthesis Design; D020521:Stroke / Q000401:mortality; D016896:Treatment Outcome