文摘
Transcatheter aortic valve implantation (TAVI) is already an accepted option to treat elderly patients with severe symptomatic aortic stenosis who are inoperable or at high surgical risk. However, short- and long-term mortality after TAVI remains an important issue, raising the need to further improve the technology of TAVI as well as to identify patients who will not benefit from TAVI. A total of 1,391 patients treated with TAVI at 27 hospitals were included in the German Transcatheter Aortic Valve Interventions - Registry. One-year follow-up data were available for 1,318 patients (94.8 % ), with a mean follow-up period of 12.9 ¡À 4.5 months. One-year mortality was 19.9 % . Survivors and nonsurvivors showed multiple differences in patient characteristics, indications for interventions, preintervention and interventional characteristics, and postintervention events. A higher logistic European System for Cardiac Operative Risk Evaluation score was associated with higher 1-year mortality (p <0.0001). Cox proportional-hazards analysis revealed the following independent predictors of mortality: among preintervention findings: previous mitral insufficiency ¡ÝII¡ã (p?= 0.0005), low-gradient aortic stenosis (p?= 0.0008), previous decompensation (p?= 0.0061), previous myocardial infarction (p?= 0.0138), renal failure (p?= 0.0180), previous New York Heart Association class IV (p?= 0.0254), and female gender (p?= 0.0346); among procedural factors: intraprocedural conversion to surgery (p?= 0.0009), peri-intervention stroke (p?= 0.0003), and residual aortic insufficiency ¡ÝII¡ã (p?= 0.0022); and among postprocedural events: postintervention myocardial infarction (p?= 0.0009) and postintervention pulmonary embolism (p?= 0.0025). In conclusion, 1-year mortality after TAVI was 19.9 % in this series. Patient characteristics and procedural as well as postintervention factors associated with mortality were identified, which may allow better patient selection and better care for these critically ill patients.