These patients were similar to the PARTNER high-risk group in age, sex, pre-op ejection fraction, and severity of Roscovitine manufacturer aortic stenosis. The perioperative mortality was 2.7% (3 of 92), and the perioperative stroke rate was 4.3% (4 of 92). The 1-year survival rate was 85% (Kaplan-Meier).

There were no periprosthetic leaks. These outcomes indicate that in selected elderly patients treated in an experienced center, surgical results superior to those receiving AVR in the PARTNER trial high-risk cohort can be achieved with fewer late complications such as ongoing strokes and progressive aortic insufficiency. Current Intrinsic Limitations of TAVI A comparison of the capabilities of TAVI vs. AVR is shown in Table 2. In our unselected Inhibitors,research,lifescience,medical total series of 1,514 AVR

patients, only 44% had undergone an isolated AVR. The remainder have received concurrent CAB, ascending aortic aneurysm repair, or mitral or tricuspid valve surgery. While Inhibitors,research,lifescience,medical most patients had pure aortic stenosis, about one-third had some degree of aortic insufficiency, which is a contraindication to TAVI. AVR allows treatment of any size of aortic “annulus” because prosthetic valves are available up to a diameter of 33 mm. Table 2 Differences in indications Inhibitors,research,lifescience,medical for TAVI vs. AVR. Ascending aortic aneurysm surgery may be required in conjunction with AVR most commonly because of atherosclerotic degeneration, Marfan’s syndrome, or aneurysmal disease from bicuspid aortic valve Inhibitors,research,lifescience,medical disease. The latter may be present in a significant proportion of these patients. Bicuspid aortic valve disease is currently considered to be a contraindication for TAVI because the single-slit opening may not conform to the circular shape of the deployed prosthesis. The aortic root and ascending aorta also tend to be larger in these patients. Patient-Prosthesis Mismatch (PPM) The TAVI prostheses are designed to have maximal geometrical orifice area. This is achieved Inhibitors,research,lifescience,medical through direct attachment of the tissue leaflets to the stent and the absence of an external sewing ring. The Medtronic CoreValve has the leaflets attached above the “annular”

fixation zone to further enhance the post-implantation effective orifice area (EOA). Despite these technical advantages, the EOA achieved by TAVI is intrinsically limited by the presence of the retained calcified aortic leaflets (which are not removed) and by the extent to which the calcified ascending aortic root and annulus can be safely dilated. In addition, the range of sizes currently available is limited. Ewe et al.11 reported on data Bumetanide from a multicenter study in which 165 patients were evaluated for PPM. Studies were performed at baseline, before hospital discharge, and 6 months after TAVI. They found that 30 patients (18.2%) had an indexed EOA of <0.85 cm2/m2. A substantially higher proportion of these patients with PPM did not show clinical improvement compared with those without PPM (36.7% vs. 1.5%, P <0.001). The major adverse cardiovascular- and valve-related events did not differ.