title: Late survival and heart failure after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Short-term survival in patients undergoing transcatheter aortic valve implantation is favorable. Our aim was to evaluate late survival and composite clinical endpoints specified by the Valve Academic Research Consortium-2, including rehospitalization for congestive heart failure.
  
  
  METHODS
  Between January 2008 and April 2014, 166 consecutive patients with severe symptomatic aortic stenosis underwent 168 transcatheter aortic valve implantation procedures at our facility. This cohort was compared with propensity score-matched aortic valve replacement patients. Event rates were estimated by the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was performed to determine predictors of outcome.
  
  
  RESULTS
  Although 30-day mortality rates following both procedures were similar (4.2% and 4.8%; p = 0.81), significant differences were seen in corresponding rates of survival (51.7% ± 5.8% vs. 72.3% ± 4.3%; p < 0.001) and cumulative rehospitalization for congestive heart failure (41.3% ± 7.2% vs. 23% ± 4.3%; p = 0.006). New York Heart Association functional class IV preoperative status was an independent risk factor for rehospitalization due to congestive heart failure (p = 0.015).
  
  
  CONCLUSIONS
  This study confirms the merit of transcatheter aortic valve implantation in high-risk patients with aortic stenosis, although late survival proved inferior to that of aortic valve replacement in propensity score-matched subjects. Early safety was excellent for both treatment groups, however, patients undergoing transcatheter aortic valve implantation had a higher incidence of rehospitalization for congestive heart failure and myocardial infarction during follow-up. Patients with severe congestive heart failure should be carefully monitored and aggressively treated to improve outcomes.
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden malin.johansson@med.lu.se.
authors.forename: Malin
authors.initials: M
authors.lastname: Johansson
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Shahab
authors.initials: S
authors.lastname: Nozohoor
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Henrik
authors.initials: H
authors.lastname: Bjursten
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Ragnarsson
authors.affiliation: Department of Coronary Heart Disease, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiology, Lund, Sweden.
authors.forename: Matthias
authors.initials: M
authors.lastname: Götberg
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Per Ola
authors.initials: PO
authors.lastname: Kimblad
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Igor
authors.initials: I
authors.lastname: Zindovic
authors.affiliation: Department of Cardiothoracic Surgery, Cardiothoracic Anesthesia and Intensive Care, Skane University Hospital, Lund, Sweden Department of Clinical Sciences, Lund Cardiothoracic Surgery, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Sjögren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology; D010359:Patient Readmission; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic valve stenosis; Cardiac catheterization; Heart failure; Heart valve prosthesis implantation; Treatment outcome