title: The risk-to-benefit ratio of transcatheter aortic valve implantation in specific patient cohorts: a single-centre experience.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has recently developed into an acceptable alternative to conventional surgery in high-risk patients. However, information on the identification of patients gaining most benefit from this procedure is still limited. The aim of this study was to evaluate safety and efficacy of TAVI in different patient cohorts.
  
  
  METHODS
  Between August 2008 and December 2010, 180 high-risk patients underwent TAVI at our institution (97 transapical and 83 transfemoral approaches). Periprocedural complications as well as mortality and incidence of MACCE during follow-up were recorded.
  
  
  RESULTS
  Mean age was 82 ± 5 years, and mean logistic EuroScore 27 ± 14%. In the total cohort, 30-day mortality was 8.9% and 12-month survival (according to Kaplan-Meier-analysis) 72%, with no significant differences between the two approaches. However, a significant difference in survival was obvious after stratification of patients according to logistic EuroScore mortality estimates. Survival proportions at 1 year were 62% in patients with logistic EuroScore >40%, 71% in patients with EuroScore 20-40% and 80% in octogenarians with EuroScore <20% (P = 0.009). Furthermore, the observed median event-free survival as an indicator for morbidity ranged between 315 days in the first, 442 days in the second and 710 days in the third group (P = 0.1).
  
  
  CONCLUSIONS
  TAVI proved to be feasible with reproducible results. However, mortality and rehospitalization rates were considerably high in specific patient cohorts, suggesting that the risk-to-benefit ratio of TAVI should be validated individually. In the present study, octogenarians with logistic EuroScore <20% could be identified as candidates apparently gaining high benefit from the procedure.
authors.affiliation: Department of Cardiology and Pneumology, Georg August University of Goettingen, Göttingen, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Puls
authors.forename: Tanja
authors.initials: T
authors.lastname: Viel
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Danner
authors.forename: Claudius
authors.initials: C
authors.lastname: Jacobshagen
authors.forename: Nils
authors.initials: N
authors.lastname: Teucher
authors.forename: Gunnar
authors.initials: G
authors.lastname: Hanekop
authors.forename: Friedrich
authors.initials: F
authors.lastname: Schöndube
authors.forename: Gerd
authors.initials: G
authors.lastname: Hasenfuss
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Seipelt
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D010359:Patient Readmission; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome