title: Midterm outcomes after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for high-risk or nonoperable patients with severe symptomatic aortic valve stenosis. The best known and most frequently implanted prostheses are the CoreValve and SAPIEN prostheses. We report our experiences and analyze the results of our TAVI program.
  
  
  METHODS
  A total of 357 patients underwent transfemoral (TF) and transapical (TA) TAVI in our center between January 2008 and October 2012. The procedure was performed in 190 patients with CoreValve, in 155 patients with SAPIEN, and in 12 patients with ACURATE TA prostheses. Transfemoral access was used in 190 patients. In 167 patients, TA access was used. The mean age was 80.2 ± 6.4 years. All patients were nonoperable or had a high risk for a conventional aortic valve replacement. The mean logistic EuroSCORE I was 25.92 ± 14.51%. The TF/CoreValve (190 patients) and TA/SAPIEN (155 patients) groups showed significant difference in the patients' mean age (81.7 ± 6.3 years vs. 79.5 ± 6.6 years, P = 0.002) and in mean logistic EuroSCORE I (22.16 ± 13.05% vs. 31.04 ± 16.40, P < 0.001).
  
  
  RESULTS
  The overall 30-day mortality (357 patients) was 9.80% (TF, 8.42%; TA, 11.37%); overall 1-year mortality (275 patients), 21.45% (TF, 23.74%; TA, 19.12%); overall 2-year mortality (199 patients), 29.15% (TF, 35.96%; TA, 23.64%); overall 3-year mortality (133 patients), 37.59% (TF, 43.86%; TA, 32.89%); and overall 4-year mortality (38 patients), 39.47% (TF, 45%; TA, 33.33%). The rate of pacemaker implantation after TAVI was significantly higher in the CoreValve group than in the SAPIEN group: 44.74% (85/190 patients) versus 6.45% (10/155 patients), P < 0.001. Stroke rate was higher in the TF-CoreValve group than in the TA-SAPIEN group: 4.21% versus 0.64%, P = 0.045.
  
  
  CONCLUSIONS
  Outcomes after TAVI were, in our population of nonoperable and high-risk patients, encouraging. The differences in midterm outcomes between the TF-CoreValve TAVI and the TA-SAPIEN TAVI were not significant.
authors.affiliation: From the Departments of *Thoracic and Cardiovascular Surgery and †Cardiology, RWTH University Clinics Aachen, Aachen; and ‡Department of Cardiac, Thoracic and Vascular Surgery, St-Johannes-Hospital, Dortmund, Germany.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfi
authors.forename: Guido
authors.initials: G
authors.lastname: Dohmen
authors.forename: Andreas
authors.initials: A
authors.lastname: Götzenich
authors.forename: Marcus
authors.initials: M
authors.lastname: Haushofer
authors.forename: Jan Wilhelm
authors.initials: JW
authors.lastname: Spillner
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D018579:Patient Selection; D011183:Postoperative Complications; D020521:Stroke / Q000209:etiology