title: Intermediate Clinical and Hemodynamic Outcomes After Transcatheter Aortic Valve Implantation.
abstract: BACKGROUND
  Concerns still exist regarding long-term results and freedom from valve-related adverse events in transcatheter aortic valve implantation (TAVI). The aim of this single-center retrospective study was to assess intermediate-term (up to 5-year) clinical and hemodynamic outcomes in patients undergoing TAVI.
  
  
  METHODS
  From 2007 through 2013, 338 consecutive patients underwent TAVI at our institution. Preoperative variables were defined according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) definitions, and outcomes were reported according to the Valve Academic Research Consortium (VARC)-2 definitions. Multivariate logistic regression analysis was performed to identify independent predictors of mortality at follow-up.
  
  
  RESULTS
  transfemoral (TF) and transapical (TA) TAVI were performed in 233 (69%) and 105 (31%) patients, respectively. All-cause 30-day mortality was 4.4%, with no differences between TA and TF procedures. Thirty-day cardiovascular death, stroke, and myocardial infarction were not different between groups. The acute kidney injury (AKI) rate was higher in the TA group (30.5% versus 11.2%; p < 0.001). Access-related complications were more frequent in the TF group (36.1% versus 11.4%; p < 0.001). Mean follow-up was 22.3 ± 17.8 months (range, 1-74 months). Overall survival rates at 1, 3, and 5 years were 85.5% ± 2.1%, 69.9% ± 3.2%, and 61% ± 4.3%, respectively. Independent predictors of all-cause mortality at follow-up were previous myocardial infarction (odds ratio [OR], 2.7), any grade of paravalvular leak (PVL) (OR, 2.5), and AKI (OR, 3.1). Mean gradient and effective orifice area at follow-up were 10.7 ± 12.0 mm Hg and 1.1 ± 0.9 cm(2)/m(2), respectively.
  
  
  CONCLUSIONS
  Our data show that TAVI has good early and intermediate-term clinical and hemodynamic outcomes in high-risk or inoperable patients with severe symptomatic aortic valve stenosis. PVL of any grade has a significant impact on survival.
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy. Electronic address: adonofrio@hotmail.it.
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Facchin
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Besola
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Manzan
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Tessari
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Bizzotto
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bianco
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarantini
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Napodano
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Fraccaro
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Buja
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Covolo
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Ermela
authors.initials: E
authors.lastname: Yzeiraj
authors.affiliation: Division of Anesthesiology, University of Padova, Italy.
authors.forename: Demetrio
authors.initials: D
authors.lastname: Pittarello
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Giambattista
authors.initials: G
authors.lastname: Isabella
authors.affiliation: Division of Cardiology, University of Padova, Italy.
authors.forename: Sabino
authors.initials: S
authors.lastname: Iliceto
authors.affiliation: Division of Cardiac Surgery, University of Padova, Italy.
authors.forename: Gino
authors.initials: G
authors.lastname: Gerosa
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome