title: The STS score is the strongest predictor of long-term survival following transcatheter aortic valve implantation, whereas access route (transapical versus transfemoral) has no predictive value beyond the periprocedural phase.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) was developed as a promising new therapy for inoperable and surgical high-risk patients as an alternative to traditional aortic valve replacement. After a successful procedure, prognosis may mainly be determined by comorbidities. However, no appropriate risk score to predict long-term outcome following TAVI is currently available. The aim of this study was to identify predictors of adverse short- and long-term outcomes.
  
  
  METHODS
  This is a two-centre registry study including a total of 426 TAVI procedures (274 transfemoral [TF] and 152 transapical [TA]) performed at the University Hospital and CardioVascular Center of Frankfurt (Germany) between 2005 and 2011.
  
  
  RESULTS
  Observed 30-day mortality was 4.8% among TF and 12.6% among TA patients (hazard ratio [HR] TF vs TA was 0.38; 95% confidence interval [CI] 0.19-0.77). Patients with a higher Society of Thoracic Surgeons (STS) score experienced a 6% elevation in the 30-day mortality per point (HR 1.06; 95% CI 1.03-1.10), whereas the predictive value of the logistic EuroSCORE (HR 1.03; 95% CI 1.01-1.05) and EuroSCORE 2 (HR 1.04; 95% CI 1.01-1.07) was slightly lower. Most interestingly, older age (>80 years) and the access type were predictors of 30-day mortality. However, the only independent predictor of long-term mortality in a 30-day landmark analysis was the STS score (HR 1.05; 95% CI 1.02-1.09).
  
  
  CONCLUSIONS
  The STS score outperforms the logistic EuroSCORE in predicting adverse outcomes following TAVI. The transapical approach is associated with higher perioperative mortality, but does not exert any influence on long-term prognosis beyond the periprocedural phase.
authors: Department of Cardiology, Johann Wolfgang Goethe-University Frankfurt, Frankfurt, Germany.
authors: Katrin
authors: K
authors: Hemmann
authors: Margarita
authors: M
authors: Sirotina
authors: Salvatore
authors: S
authors: De Rosa
authors: Joachim R
authors: JR
authors: Ehrlich
authors: Henrik
authors: H
authors: Fox
authors: Johannes
authors: J
authors: Weber
authors: Anton
authors: A
authors: Moritz
authors: Andreas M
authors: AM
authors: Zeiher
authors: Ilona
authors: I
authors: Hofmann
authors: Volker
authors: V
authors: Schächinger
authors: Mirko
authors: M
authors: Doss
authors: Horst
authors: H
authors: Sievert
authors: Stephan
authors: S
authors: Fichtlscherer
authors: Ralf
authors: R
authors: Lehmann
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality; D003661:Decision Support Techniques; D005260:Female; D005263:Femoral Artery; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006785:Hospitals, University; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Apical; Femoral; Long-term outcome; STS score; Transcatheter aortic valve implantation
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