title: Transapical aortic valve implantation: experiences and survival analysis up to three years.
abstract: BACKGROUND
  We determined our 30-day results after transapical aortic valve implantation (TA-AVI) according to Valve Academic Research Consortium criteria, analyzed midterm outcome, and summarize our institutional learning experience.
  
  
  METHODS
  From February 2008 to July 2011, 150 high-risk patients underwent TA-AVI. Endpoints of this retrospective analysis were safety as indicated by morbidity and 30-day mortality and midterm survival with a follow-up period up to 3.4 years (mean follow-up 14.1 months). In addition we analyzed our institutional learning curve by comparing the outcome of our first 50 patients (group 1) to the following 100 patients (group 2).
  
  
  RESULTS
  Procedural success was 98% (147 patients). All-cause and cardiovascular cause 30-day mortality was 11.3% (n = 17) and 7.3% (n = 11), respectively. The cumulative survival rates were 78.7% at one year, 62.8% at two years, and 50.8% at three years. As compared to group 1, there was a significantly reduced incidence of relevant bleeding complications (0% vs. 14%[n = 7]; p < 0.001) and a reduced incidence of acute kidney injury (35%[n = 35] versus 56% (n = 28); p < 0.05) in group 2, resulting in a combined safety endpoint at 30 days of 22% in group 2 versus 40% in group 1 (p < 0.05). One-year mortality (group 2, n = 20 [20%] versus group 1, n = 10 [20%]; p = 1) and midterm survival (p = 0.998; Hazard ratio 1.001; 95% CI 0.5141 to 1.949) did not differ significantly.
  
  
  CONCLUSIONS
  Although the incidence of technical complications decreased significantly over time, 30-day and midterm mortality were unaltered, most likely due to patients' comorbidities. The development of more accurate risk scores may improve future outcome.
authors.affiliation: Department of Cardiothoracic Surgery Department of Cardiology, University Hospital of Cologne, Cologne, Germany. maximilian.scherner@uk-koeln.de
authors.forename: Maximilian
authors.initials: M
authors.lastname: Scherner
authors.forename: Navid
authors.initials: N
authors.lastname: Madershahian
authors.forename: Stephan
authors.initials: S
authors.lastname: Rosenkranz
authors.forename: Ingo
authors.initials: I
authors.lastname: Slottosch
authors.forename: Elmar
authors.initials: E
authors.lastname: Kuhn
authors.forename: Georg
authors.initials: G
authors.lastname: Langebartels
authors.forename: Antje
authors.initials: A
authors.lastname: Deppe
authors.forename: Jens
authors.initials: J
authors.lastname: Wippermann
authors.forename: Yeong-Hoon
authors.initials: YH
authors.lastname: Choi
authors.forename: Justus T
authors.initials: JT
authors.lastname: Strauch
authors.forename: Thorsten
authors.initials: T
authors.lastname: Wahlers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome