title: Clinical outcomes of patients with estimated low or intermediate surgical risk undergoing transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an established treatment alternative to surgical aortic valve replacement in high-risk and inoperable patients and outcomes among patients with estimated low or intermediate risk remain to be determined. The aim of this study was to assess clinical outcomes among patients with estimated low or intermediate surgical risk undergoing TAVI.
  
  
  RESULTS
  Between August 2007 and October 2011, 389 consecutive patients underwent TAVI and were categorized according to the Society of Thoracic Surgeons (STS) score into low (STS < 3%; n = 41, 10.5%), intermediate (STS ≥3% and ≤8%, n = 254, 65.3%), and high-risk (STS > 8%; n = 94, 24.2%) groups for the purpose of this study. Significant differences were found between the groups (low risk vs. intermediate risk vs. high risk) for age (78.2 ± 6.7 vs. 82.7 ± 5.7 vs. 83.7 ± 4.9, P < 0.001), body mass index (28.1 ± 6.1 vs. 26.5 ± 4.9 vs. 24.4 ± 4.6, P < 0.001), chronic renal failure (34 vs. 67 vs. 90%, P < 0.001), all-cause mortality at 30 days (2.4 vs. 3.9 vs. 14.9%, P = 0.001), and all-cause mortality at 1 year (10.1 vs. 16.1 vs. 34.5%, P = 0.0003). No differences were observed with regards to cerebrovascular accidents and myocardial infarction during 1-year follow-up.
  
  
  CONCLUSIONS
  In contemporary practice, TAVI is not limited to inoperable or STS-defined high-risk patients and should be guided by the decision of an interdisciplinary Heart Team. Compared with patients at calculated high risk, well-selected patients with STS-defined intermediate or low risk appear to have favourable clinical outcomes.
authors.affiliation: Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Switzerland. peter.wenaweser@insel.ch
authors.forename: Peter
authors.initials: P
authors.lastname: Wenaweser
authors.forename: Stefan
authors.initials: S
authors.lastname: Stortecky
authors.forename: Sarah
authors.initials: S
authors.lastname: Schwander
authors.forename: Dik
authors.initials: D
authors.lastname: Heg
authors.forename: Christoph
authors.initials: C
authors.lastname: Huber
authors.forename: Thomas
authors.initials: T
authors.lastname: Pilgrim
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.forename: Crochan J
authors.initials: CJ
authors.lastname: O'Sullivan
authors.forename: Bernhard
authors.initials: B
authors.lastname: Meier
authors.forename: Peter
authors.initials: P
authors.lastname: Jüni
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.forename: Stephan
authors.initials: S
authors.lastname: Windecker
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods* / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic stenosis; Intermediate risk; Risk stratification; TAVI; Transcatheter aortic valve implantation