title: Medium term outcomes of transapical aortic valve implantation: results from the Italian Registry of Trans-Apical Aortic Valve Implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has been proposed as a therapeutic option for high-risk or inoperable patients with severe symptomatic aortic valve stenosis. The aim of this multicenter study was to assess early and medium term outcomes of transapical aortic valve implantation (TA-TAVI).
  
  
  METHODS
  From April 2008 through June 2012, a total of 774 patients were enrolled in the Italian Registry of Trans-Apical Aortic Valve Implantation (I-TA). Twenty-one centers were included in the I-TA registry. Outcomes were also analyzed according to the impact of the learning curve (first 50% cases versus second 50% cases of each center) and of the procedural volume (high-volume versus low-volume centers).
  
  
  RESULTS
  Mean age was 81.0±6.7 years, mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) I, EuroSCORE II, and The Society of Thoracic Surgeons risk score were 25.6%±16.3%, 9.4%±11.0%, and 10.6%±8.5%, respectively. Median follow-up was 12 months (range, 1 to 44). Thirty-day mortality was 9.9% (77 patients). Overall 1-, 2-, and 3-year survival was 81.7%±1.5%, 76.1%±1.9%, and 67.6%±3.2%, respectively. Thirty-day mortality of the first 50% patients of each center was higher when compared with the second half (p=0.04) but 3-year survival was not different (p=0.64). Conversely, 30-day mortality at low-volume centers versus high-volume centers was similar (p=0.22). At discharge, peak and mean transprosthetic gradients were 21.0±10.3 mm Hg and 10.2±4.1 mm Hg, respectively. These values remained stable 12 and 24 months after surgery.
  
  
  CONCLUSIONS
  Transapical TAVI provides good results in terms of early and midterm clinical and hemodynamic outcomes. Thus it appears to be a safe and effective alternative treatment for patients who are inoperable or have high surgical risk.
authors.affiliation: Division of Cardiac Surgery, University of Padova, Padova, Italy. adonofrio@hotmail.it
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Stefano
authors.initials: S
authors.lastname: Salizzoni
authors.forename: Marco
authors.initials: M
authors.lastname: Agrifoglio
authors.forename: Linda
authors.initials: L
authors.lastname: Cota
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Luzi
authors.forename: Paolo M
authors.initials: PM
authors.lastname: Tartara
authors.forename: Giovanni D
authors.initials: GD
authors.lastname: Cresce
authors.forename: Marco
authors.initials: M
authors.lastname: Aiello
authors.forename: Carlo
authors.initials: C
authors.lastname: Savini
authors.forename: Mauro
authors.initials: M
authors.lastname: Cassese
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cerillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Punta
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Davide
authors.initials: D
authors.lastname: Gabbieri
authors.forename: Chiara
authors.initials: C
authors.lastname: Zanchettin
authors.forename: Andrea
authors.initials: A
authors.lastname: Agostinelli
authors.forename: Enzo
authors.initials: E
authors.lastname: Mazzaro
authors.forename: Omar
authors.initials: O
authors.lastname: Di Gregorio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gatti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.forename: Claudia
authors.initials: C
authors.lastname: Filippini
authors.forename: Mauro
authors.initials: M
authors.lastname: Rinaldi
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D004452:Echocardiography / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome
keywords: 35