title: Impact of aortic valve calcification on the outcome of transcatheter aortic valve implantation: results from the prospective multicenter German TAVI registry.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an emerging technology in patients with severe aortic stenosis.
  
  
  BACKGROUND
  Whether the degree of aortic valve calcification impacts the outcome after TAVI has not been thoroughly evaluated.
  
  
  METHODS
  We analyzed data from the prospective multicenter German TAVI registry, including 1,365 patients as of July 2010. Patients were divided into three groups, based on the degree of aortic valve calcification: mild (n = 67), moderate (n = 392), and severe (n = 906) valve calcification, determined by visual estimation by the operator.
  
  
  RESULTS
  Mean age was 81.7 ± 6.2 years; mean logistic EUROscore was 20.6 ± 13.7%. Patients with severe aortic valve calcification had a higher mean and peak-to-peak gradient before the intervention (P < 0.0001). Technical success was achieved in 97%, similar in each group. The Medtronic CoreValve was implanted in 80.8%, the Sapien Edwards prosthesis in the remaining cases. The duration of the procedure and fluoroscopy was higher in the group with severe calcification (P < 0.01 for procedure and P < 0.05 for fluoroscopy). During the periprocedural period there were no differences among the groups regarding in-hospital death, cerebrovascular events, myocardial infarction, thromboembolic events, aortic dissection, or severe vascular complications. Furthermore, there was no significant difference in postprocedural aortic mean gradient (7.0 mm Hg vs. 5.6 mm Hg vs. 6.3 mm Hg; P = 0.07), in residual aortic regurgitation (74% vs. 72% vs. 68%; P = 0.3) or postprocedure pacemaker implantation (38% vs. 30.4% vs. 34.2%; P = 0.35). During 30-day follow up there was no difference in regard to the number of death, strokes, and myocardial infarctions.
  
  
  CONCLUSIONS
  Our results of a real-world registry suggest that the extent of aortic valve calcification does not influence the success or procedural outcome significantly.
authors.affiliation: CardioVascular Center Frankfurt, Sankt Katharinen und Universitätsklinikum Frankfurt, Frankfurt, Germany. stephanstaubach@gmail.com
authors.forename: Stephan
authors.initials: S
authors.lastname: Staubach
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gerckens
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Martin
authors.initials: M
authors.lastname: Horack
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Steinberg
authors.forename: Jakob
authors.initials: J
authors.lastname: Ledwoch
authors.forename: Stephan
authors.initials: S
authors.lastname: Fichtlscherer
authors.forename: Mirko
authors.initials: M
authors.lastname: Doss
authors.forename: Nina
authors.initials: N
authors.lastname: Wunderlich
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000628:therapy; D002114:Calcinosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002304:Cardiac Pacing, Artificial; D005260:Female; D005858:Germany; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome