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You are here: Contents > 2013 > Volume 22 Number 1 January 2013 > AORTIC VALVE DISEASE > Two-Year Mortality after Transcatheter Aortic Valve Implantation Versus Medical Therapy for High-Surgical Risk or Inoperable Aortic Stenosis Patients

Two-Year Mortality after Transcatheter Aortic Valve Implantation Versus Medical Therapy for High-Surgical Risk or Inoperable Aortic Stenosis Patients

Rainer Hoffmann, Bader Almutairi, Ralf Herpertz, Sara Lotfipour, Robert Stöhr, Ömer Aktug, Kathrin Brehmer, Emilia Stegemann, Rüdiger Autschbach, Nikolaus Marx, Guido Dohmen

Medical Clinic I and Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany

Background and aim of the study: Transcatheter aortic valve implantation (TAVI) has become a therapeutic option for the treatment of high-risk or inoperable patients with symptomatic severe aortic stenosis. The study aim was to compare the two-year mortality of high-risk or inoperable patients treated by TAVI compared to medical therapy, in a single-center setting. Methods: A total of 135 consecutive patients (58 males, 77 females; mean age 80 ± 6 years; logistic EuroSCORE 21 ± 13%) who had undergone TAVI was compared to 135 patients (60 males, 75 females; mean age 79 ± 3 years; logistic EuroSCORE 21 ± 19%) who had undergone medical treatment before TAVI became available. The one- and two-year follow up mortalities were recorded for each group. In the TAVI group, the patient characteristics were analyzed for predictors of mortality. Results: Sixteen patients (12%) in the TAVI group and 10 (7%) in the medically treated group died within 30 days of intervention or presentation (p = 0.303). At the one-year

follow up, 28 TAVI patients (21%) and 69 medically treated patients (41%) died (p <0.001). At the two-year follow up, 41 TAVI patients (30%) and 80 medically treated patients (59%) died (p <0.001). Log-rank analysis demonstrated a significant survival benefit after TAVI compared to medical treatment during the total follow up period. Univariate predictors of death at the two-year follow up included medical therapy, logistic EuroSCORE, and pulmonary hypertension. Medical therapy remained the only independent predictor of two-year mortality in a multivariate analysis (OR 3.343; 95% CI 2.021-6.234, p <0.001). Conclusion: In high-surgical risk or inoperable symptomatic aortic stenosis patients, the one- and two-year follow up mortalities of patients treated with TAVI was significantly lower than after medical therapy. Predictors of mortality, in addition to treatment strategy, were pulmonary hypertension and EuroSCORE.

The Journal of Heart Valve Disease 2013;22:71-78

Two-Year Mortality after Transcatheter Aortic Valve Implantation Versus Medical Therapy for High-Surgical Risk or Inoperable Aortic Stenosis Patients

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