title: Two-year mortality after transcatheter aortic valve implantation versus medical therapy for high-surgical risk or inoperable aortic stenosis patients.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for the treatment of high-risk or inoperable patients with symptomatic severe aortic stenosis. The study aim was to compare the two-year mortality of high-risk or inoperable patients treated by TAVI compared to medical therapy, in a single-center setting.
  
  
  METHODS
  A total of 135 consecutive patients (58 males, 77 females; mean age 80 +/- 6 years; logistic EuroSCORE 21 +/- 13%) who had undergone TAVI was compared to 135 patients (60 males, 75 females; mean age 79 +/- 3 years; logistic EuroSCORE 21 +/- 19%) who had undergone medical treatment before TAVI became available. The one- and two-year follow up mortalities were recorded for each group. In the TAVI group, the patient characteristics were analyzed for predictors of mortality.
  
  
  RESULTS
  Sixteen patients (12%) in the TAVI group and 10 (7%) in the medically treated group died within 30 days of intervention or presentation (p = 0.303). At the one-year follow up, 28 TAVI patients (21%) and 69 medically treated patients (41%) died (p < 0.001). At the two-year follow up, 41 TAVI patients (30%) and 80 medically treated patients (59%) died (p < 0.001). Log-rank analysis demonstrated a significant survival benefit after TAVI compared to medical treatment during the total follow up period. Univariate predictors of death at the two-year follow up included medical therapy, logistic EuroSCORE, and pulmonary hypertension. Medical therapy remained the only independent predictor of two-year mortality in a multivariate analysis (OR 3.343; 95% CI 2.021-6.234, p < 0.001).
  
  
  CONCLUSIONS
  In high-surgical risk or inoperable symptomatic aortic stenosis patients, the one- and two-year follow up mortalities of patients treated with TAVI was significantly lower than after medical therapy. Predictors of mortality, in addition to treatment strategy, were pulmonary hypertension and EuroSCORE.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Aachen, Germany. RHoffmann@UKAACHEN.de
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
authors.forename: Bader
authors.initials: B
authors.lastname: Almutairi
authors.forename: Ralf
authors.initials: R
authors.lastname: Herpertz
authors.forename: Sara
authors.initials: S
authors.lastname: Lotfipour
authors.forename: Robert
authors.initials: R
authors.lastname: Stöhr
authors.forename: Omer
authors.initials: O
authors.lastname: Aktug
authors.forename: Kathrin
authors.initials: K
authors.lastname: Brehmer
authors.forename: Emilia
authors.initials: E
authors.lastname: Stegemann
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.forename: Guido
authors.initials: G
authors.lastname: Dohmen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000188:drug therapy / Q000401:mortality* / Q000601:surgery; D057510:Endovascular Procedures / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors