title: Conventional aortic valve replacement in transcatheter aortic valve implantation candidates: a 5-year experience.
abstract: BACKGROUND
  Patient selection for transcatheter aortic valve implantation (TAVI) remains highly controversial. Some screened patients subsequently undergo conventional aortic valve replacement (AVR) because they are unsuitable TAVI candidates. This study examined the indications and outcomes for these patients, thereby determining the efficacy of the screening process.
  
  
  METHODS
  Between January 2006 and December 2010, 79 consecutive patients (49% men), aged older than 75 years with high surgical risk, were screened for TAVI, but subsequently underwent conventional AVR through a partial or complete sternotomy. The indications, demographics, and outcomes of this cohort were studied.
  
  
  RESULTS
  Mean age was 80.4±3.6 years. Mean left ventricular ejection fraction was 0.55±0.16, and the mean logistic European System for Cardiac Operative Risk Evaluation was 13%±7%. Of the 79 patients, 6 (7.6%) had prior cardiac surgical procedures. Indications for TAVI denial after patient evaluations were a large annulus in 31 (39%), acceptable risk profile for AVR in 24 (30%), need for urgent operation in 11 (14%), and concomitant cardiovascular pathology in 5 (6%). Mean cross-clamp time was 55±14 minutes, and cardiopulmonary bypass time was 81±21 minutes. Concomitant procedures included a Maze in 12 patients (15%). Postoperative morbidity included permanent stroke in 2 (2.5%), respiratory failure in 9 (11%), and pacemaker implantation in 2 (2.5%). Hospital mortality was 1.3% (1 of 79). Cumulative survival at 6, 12, and 36 months was 88.5%, 87.1% and 72.7%, respectively.
  
  
  CONCLUSIONS
  Our existing patient evaluation process accurately defines an acceptable risk cohort for conventional AVR. The late mortality rate reflects the advanced age and comorbidities of this cohort. The data suggest that overzealous widening of TAVI inclusion criteria may be inappropriate.
authors: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany. ssubramanian@surgery.arizona.edu
authors: Sreekumar
authors: S
authors: Subramanian
authors: Ardawan J
authors: AJ
authors: Rastan
authors: David
authors: D
authors: Holzhey
authors: Martin
authors: M
authors: Haensig
authors: Joerg
authors: J
authors: Kempfert
authors: Michael A
authors: MA
authors: Borger
authors: Thomas
authors: T
authors: Walther
authors: Friedrich W
authors: FW
authors: Mohr
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis; D016896:Treatment Outcome