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Background: Patient selection for transcatheter aortic valve implantation (TAVI) remains a major concern. Indeed, despite promising results, it is still unclear which patients are most and least likely to benefit from this procedure., Aims: To identify predictors of 6-month poor clinical outcomes after TAVI., Methods: Patients who were discharged from our institution with a transcatheter-implanted aortic valve were followed prospectively. Our population was divided into two groups ('good outcomes' and 'poor outcomes') according to occurrence of primary endpoint (composite of all-cause mortality, all stroke, hospitalizations for valve-related symptoms or worsening heart failure from discharge to 6 months or 6-month New York Heart Association functional class III or IV). Patient characteristics were studied to find predictors of poor outcomes., Results: We included 163 patients (mean age, 79.9 ± 8.8 years; 90 men [55%]; mean logistic EuroSCORE, 18.4 ± 11.4%). The primary endpoint occurred in 49 patients (mean age, 83 ± 5 years; 31 men [63%]). By multivariable analysis, atrial fibrillation (odds ratio [OR] 3.94), systolic pulmonary artery pressure ≥60 mmHg (OR 7.56) and right ventricular dysfunction (OR 3.55) were independent predictors of poor outcomes, whereas baseline aortic regurgitation ≥2/4 (OR 0.07) demonstrated a protective effect., Conclusion: Atrial fibrillation, severe baseline pulmonary hypertension and right ventricular dysfunction (i.e. variables suggesting a more evolved aortic stenosis) were predictors of 6-month poor outcomes. Conversely, baseline aortic regurgitation ≥2/4 showed a protective effect, which needs to be confirmed in future studies. Our study highlights the need for a specific 'TAVI risk score', which could lead to better patient selection., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Background: The operative risk of cardiac surgery is ascertained preoperatively on the basis of scores validated in multinational studies. However, the value they add to a simple bedside clinical evaluation (CE) remains controversial., Aims: To compare operative mortality (defined as death from all causes before the 31st postoperative day) predicted by CE with that predicted by additive and logistic EuroSCOREs, EuroSCORE II and Society of Thoracic Surgeons (STS), Ambler and age-creatinine-ejection fraction (ACEF) scores in patients undergoing aortic valve replacement (AVR) for severe aortic stenosis., Methods: Overall, 314 consecutive patients were included who underwent AVR between October 2009 and November 2011 (22% with coronary artery bypass graft); mean age 73.4 ± 9.7 years (29% aged>80 years). Based on CE, patients were divided into four predefined groups of increasing estimated mortality risk: I ≤ 3.9%; II 4-6.9%; III 7-9.9%; IV ≥ 10%. The positive and negative predictive values of the six scores and CE were compared., Results: The observed overall operative mortality was 5.7%. The distribution of the four predicted mortality groups by each score was highly variable. The positive predictive value, calculated for the 64 patients classified at highest risk by CE (groups III or IV) or each score, was 17.2% for EuroSCORE II, 14.1% for CE and STS scores, 10.9% for additive and logistic EuroSCOREs, 10.6% for ACEF and 10.2% for Ambler. The positive predictive value of each score in the low-risk groups (I and II) ranged from 2.8% to 4.4%., Conclusion: A simple bedside CE appears as reliable as the various established scores for predicting operative risk in patients undergoing surgical aortic valve replacement. The development and validation of more comprehensive risk stratification tools, including risk factors thus far neglected, seems warranted., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Aims: Exercise stress testing (EST) is recommended by guidelines to risk-stratify patients with asymptomatic valvular aortic stenosis (AS), though the role of quantitative exercise-Doppler echocardiography has rarely been studied. This prospective study sought to correlate standard EST results with the haemodynamic measurements made during exercise by Doppler echocardiography., Methods and Results: We performed rest and semi-supine exercise Doppler echocardiography in 44 consecutive patients (mean age=68+/-12 years) with aortic valve areas

Objectives: We evaluated a large multicenter series of patients operated on for low-flow/low-gradient aortic stenosis (LF/LGAS) to stratify the operative risk, assess whether perioperative mortality has decreased over recent years, and analyze the post-operative outcome., Background: Although LF/LGAS is classically associated with a high operative risk, few data are available concerning the results of surgery in this setting., Methods: A total of 217 consecutive patients (168 men, 77%) with severe aortic stenosis (area <1 cm(2)), low ejection fraction (EF) (

Population aging in industrialized countries and advances in surgical care are leading to an increased number of elderly patients referred for surgical management of aortic stenosis (AS). Our report is a retrospective review of 988 consecutive patients aged 80 to 93 years (mean 82.4 +/- 2.3) who had aortic valve replacement (AVR) for AS. Surgical mortality was 9.4% (93 patients). Among 895 operative survivors, follow-up rate has been 99.7%, total 4446 patient-years (mean 5 +/- 3 years, max 19 years). Actuarial survival including operative mortality was 82%, 59% and 23% at two, five and ten years respectively. Functionnal recovery was excellent (46 % NYHA I and 43% NYHA II). Long term survival paralleled that of age and sex matched control population. Age itself is no longer a contraindication to surgery and AVR is the procedure of choice for elderly patients with aortic stenosis. Percutaneous aortic valve implantation is feasible and requires evaluation. It might become an alternative for selected high-risk non surgical patients with AS.