title: Prevalence, clinical characteristics and outcomes of high-risk patients treated for severe aortic stenosis prior to and after transcatheter aortic valve implantation availability.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) has emerged as an effective treatment for high-risk patients with severe aortic stenosis (AS). The aim of our study was to compare the prevalence, characteristics and outcomes of high-risk patients treated prior to and after the availability of TAVI in our high-volume surgical institution.
  
  
  METHODS
  Among 879 consecutive patients treated 2 years before ('pre-TAVI era') and after ('modern era') the availability of TAVI in our institution, 83 patients were at high risk [defined by logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) >20%].
  
  
  RESULTS
  Among all patients treated for severe AS, the prevalence of high-risk patients was higher in the modern era (12.7 vs 4.9%, P < 0.0001). In the modern era, high-risk patients were treated by TAVI in 89% of cases. Despite similar logistic EuroSCORE (34.9 vs 34%, P = 0.96), the clinical characteristics of these patients have evolved: high-risk patients in the modern era were older (85.3 ± 5.9 vs 78.5 ± 6.5 years, P = 0.0005) and presented more frequently with New York Heart Association class III-IV (92.3 vs 61.1%, P = 0.003), while high-risk patients treated by surgical aortic valve replacement in the pre-TAVI era presented more frequently with a critical preoperative status (33.3 vs 7.7%, P = 0.01), lower left ventricular ejection fraction (41 ± 14 vs 49 ± 15%, P = 0.05) and a history of recent myocardial infarction (27.8 vs 6.1%, P = 0.02). The overall 1-year survival was not different for high-risk patients treated in the pre-TAVI era or in the modern era (61 ± 11 vs 68 ± 6%, P = 0.52).
  
  
  CONCLUSIONS
  The availability of TAVI has increased the prevalence of high-risk patients treated for severe AS and changed the clinical features of this kind of patients who were rarely surgically treated before. The 1-year survival was similar between pre-TAVI and modern eras.
authors: Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France d.attias@ccncardio.com.
authors: David
authors: D
authors: Attias
authors: Intensive Care Unit Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Jean-Michel
authors: JM
authors: Maillet
authors: Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Xavier
authors: X
authors: Copie
authors: Cardio-thoracic Surgery Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Nicolas
authors: N
authors: Bonnet
authors: Cardio-thoracic Surgery Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Patrick
authors: P
authors: Mesnildrey
authors: Intensive Care Unit Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Christophe
authors: C
authors: Benvenuti
authors: Intensive Care Unit Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Marc
authors: M
authors: Benacerraf
authors: Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Aliocha
authors: A
authors: Scheublé
authors: Interventional Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Franck
authors: F
authors: Digne
authors: Interventional Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Victor
authors: V
authors: Stratiev
authors: Interventional Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France.
authors: Philippe
authors: P
authors: Guyon
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome
keywords: Aortic stenosis; Aortic valve replacement; High risk; Transcatheter aortic valve implantation