title: Conventional surgery results in patients originally referred for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is increasingly considered as a viable alternative to conventional aortic valve replacement (AVR) in high-risk patients. Long-term results, however, are still scarce and medical community hesitates in enlarging indications to lower-risk patients. Moreover, available devices are expensive and a strict potential candidate selection is necessary.
  
  
  METHODS
  From April 2008 to August 2012, a total of 212 patients, originally referred for percutaneous treatment, were thoroughly evaluated by the aortic team of our department in order to choose the optimal procedure. Of them, 55 patients (35 women; 20 men) were considered as still acceptable candidates for conventional AVR.
  
  
  RESULTS
  Mean age was 80.7 ± 4.7 years; mean additive and logistic Euroscore I were 9.7 ± 1.8 and 17.8 ± 9.5%, respectively. Mean Euroscore II was 7.9 ± 5.5%. Mean New York Heart Association class was 2.9 ± 0.5. The majority of patients (87.2%) presented a geriatric frailty score of 0-1. Four patients showed a heavily calcified ascending aorta, and five patients (9%) underwent reoperations. Hospital mortality was 10.9% (six patients). Mean follow-up was 535.9 ± 407.4 days (range: 6-1365 days). Six other patients died during this period for a mean survival of 74.4 ± 6.9% at 2 years. Mean New York Heart Association class at 1 year was 1.25 ± 0.5 (P < 0.01 vs. preoperative value).
  
  
  CONCLUSIONS
  AVR should be indicated with caution in high-risk patients originally referred for TAVI. Despite medium-term results being good, with excellent functional status, hospital mortality is not negligible.
authors.affiliation: aDepartments of Cardiac Surgery bInterventional Cardiology cAcademic Cardiology dCardiology, Ospedali Riuniti di Ancona, Ancona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rescigno
authors.forename: Tommaso
authors.initials: T
authors.lastname: Piva
authors.forename: Ilaria
authors.initials: I
authors.lastname: Mazzanti
authors.forename: Carlo
authors.initials: C
authors.lastname: Aratari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pupita
authors.forename: Sacha
authors.initials: S
authors.lastname: Matteucci
authors.forename: Alessandro
authors.initials: A
authors.lastname: D'Alfonso
authors.forename: Alessandro
authors.initials: A
authors.lastname: Capucci
authors.forename: Gian Piero
authors.initials: GP
authors.lastname: Perna
authors.forename: Lucia
authors.initials: L
authors.lastname: Torracca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D018579:Patient Selection; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D016896:Treatment Outcome