title: Predictors and outcomes after transcatheter aortic valve implantation using different approaches according to the valve academic research consortium definitions.
abstract: OBJECTIVE
  We report the results of a large single-center study evaluating predictors and outcomes after transcatheter aortic valve implantation (TAVI) with different devices and access routes according to the Valve Academic Research Consortium (VARC).
  
  
  BACKGROUND
  The widespread adoption of TAVI warrants a systematic analysis of outcomes. Only few comprehensive data exist comparing different approaches as selected by a heart team.
  
  
  METHODS
  TAVI was performed in 326 consecutive patients (mean age 80.6 ± 7.1 years, 55.5% female) at high risk for surgery with balloon-expandable and self-expanding devices through transfemoral or transapical access. Data were analyzed according to VARC endpoints; predictors of mortality were identified.
  
  
  RESULTS
  All-cause mortality was 10.1% (30 days) and 29.9% (1 year) overall and comparable with regard to valve or access choice (P = 0.295) despite different risk profiles at baseline. Device success and 30-day safety endpoints were achieved in 87.1 and 21.2%. Myocardial infarction [hazard ratio (HR) 6.52], stage-2 and -3 acute kidney injury (HR 2.52 and 6.80) and major access site complications (HR 1.96) were independent predictors of 1-year all-cause mortality. Device success had a protective effect (HR 0.58). Baseline predictors included body mass index <20 kg/m(2) (HR 3.20), NYHA class IV (HR 1.87), left ventricular ejection-fraction <30% (HR 2.30), higher STS-PROM scores (HR 1.05 per percent), and age (group 75-85 years, HR 0.47).
  
  
  CONCLUSIONS
  Comparable results were achieved with different devices and access routes in a heart team approach. Baseline and perioperative predictors of all-cause mortality were identified, contributing to the refinement of patient and device selection criteria for TAVI.
authors.affiliation: Department of Cardiovascular Surgery, University Heart Center, Hamburg, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Seiffert
authors.forename: Renate
authors.initials: R
authors.lastname: Schnabel
authors.forename: Lenard
authors.initials: L
authors.lastname: Conradi
authors.forename: Patrick
authors.initials: P
authors.lastname: Diemert
authors.forename: Johannes
authors.initials: J
authors.lastname: Schirmer
authors.forename: Dietmar
authors.initials: D
authors.lastname: Koschyk
authors.forename: Matthias
authors.initials: M
authors.lastname: Linder
authors.forename: Jan F
authors.initials: JF
authors.lastname: Kersten
authors.forename: Andrea
authors.initials: A
authors.lastname: Grosser
authors.forename: Sandra
authors.initials: S
authors.lastname: Wilde
authors.forename: Stefan
authors.initials: S
authors.lastname: Blankenberg
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Hendrik
authors.initials: H
authors.lastname: Treede
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D063126:Balloon Valvuloplasty; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002983:Clinical Competence; D005260:Female; D005858:Germany; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality; D018579:Patient Selection; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left