Transapical Approach Research Articles

176-I * TRANSAPICAL APPROACH IN REDO MYECTOMY FOR HYPERTROPHIC CARDIOMYOPATHY

Objectives: Reoperation for recurrent or residual gradients after septal myectomy offers symptomatic relief and restores life span. In selected patients, septal myectomy needs to be performed through a transapical approach. Methods: We present the case of a 35-year-old female that underwent transaortic septal myectomy 2 years ago. She presented with class IV symptoms and significant residual obstruction. Additionally she had severe tricuspid regurgitation secondary to an internal cardiodefibrillator lead. Echocardiographic evaluation demonstrated subaortic and midventricular obstruction. We describe our surgical approach. Results: She underwent redo sternotomy and tricuspid valve repair. A repeat transaortic myectomy was attempted but exposure of septum was not appropriate and we performed a midventricular and low subaortic septal myectomy through an apical incision. Conclusion: Transapical septal myectomy is safe and provides excellent exposure for midventricular obstruction relief. In selected patients with difficult transaortic exposure it may allow basal myectomy. Complete relief of obstruction improves symptoms.

Endovascular stent grafting for ascending aorta repair in high-risk patients

Standard treatment of ascending aortic pathology is open repair, but some patients are too high risk. Thoracic endovascular aortic repair (TEVAR) of the ascending aorta has been used as an alternative. Our objectives were to characterize patients, describe repair methods, and assess outcomes. From 2006 to 2014, 22 patients underwent supracoronary ascending TEVAR for acute Type A dissection (n=9), intramural hematoma (n=2), pseudoaneurysm (n=9), chronic dissection (n=2), or aorta-cardiac fistula (n=2). Mean age was 71 ± 13 years and the maximum proximal aortic diameter was 6± 1 cm. Devices were delivered via a transfemoral (n=10), transapical (n=7), or axillary (n=5) artery approach. The proximal landing zone was at the sinotubular junction in 14 patients, mid to distal ascending aorta in 3 patients, and surgical graft from previous ascending repair in 5 patients. More than 1 device was used in 15patients. Imaging and engineering analysis was performed for all patients. There were 3 hospital deaths (13.6%) (tamponade in 1 patient, bleed from left atrial fistula in another patient). One patient had partial occlusion of the left coronary artery requiring open conversion and died later from multiorgan failure. One patient required early open conversion for retained delivery system. There were 3 strokes, 2 myocardial infarctions, and 2 tracheostomies, but there was no new-onset renal failure. Median follow-up was 12 months. Six patients developed type 1 endoleak: 2 were treated endovascularly, 1 with open repair, 1 resolved, 1 refused treatment, and 1 is being watched. In 2 patients, initial TEVAR was performed as a bridge for ruptured high-risk dissection and were later converted to open repair. Reoperations also included removal of stent graft due to distal migration and repair of left ventricular pseudoaneurysm. There were 3 late deaths. Actual survival at 30 days, 1 year, and 5 years was 86%, 80%, and 75%, respectively. Ascending TEVAR is a feasible alternative to medical therapy for repair of acute and chronic ascending disease in high-risk patients. Development of devices dedicated to treat ascending aortic pathology is needed to improve outcomes.

Impact of access on TAVI procedural and midterm follow-up: a meta-analysis of 13 studies and 10,468 patients.

Transcatheter aortic valve implantation (TAVI) may be performed using the transfemoral (TF) or transapical (TA) approach in most patients with aortic stenosis. The impact of access choice on peri-procedural and midterm results remains to be defined. Medline and Cochrane Library were searched for articles describing differences in baseline, peri-procedural, and midterm outcomes among patients undergoing TF or TA TAVI. The primary end-point was all-cause mortality after at least 1-year follow-up, while secondary end-points were 30 days mortality and in-hospital complications (bleeding and cerebrovascular events). The independent impact of access choice was evaluated with pooled analysis using a random-effect model. Thirteen studies with 10,468 patients were included. TF was the most exploited strategy (69.5% vs. 30.5%). After adjusting for confounding variables, 30-day and midterm follow-up mortality (median 365 days, range 222-400) were lower in TF patients with a pooled adjusted odds ratio of 0.81 (0.68-0.97 I(2) 99%) and 0.85 (0.80-0.90 I(2) 96%), respectively. Regarding periprocedural outcomes, TF reduced risk of bleedings and strokes (OR of 0.74 [0.66-0.82 I(2) 95%] and 0.91 [0.83-0.99] I(2) 86%, respectively). The TF approach reduces mortality in TAVI patients, due to lower rates of periprocedural bleedings and strokes.

Single-center experience and short-term outcome with the JenaValve: a second-generation transapical transcatheter aortic valve implantation device.

We present the post-CE(Conformité Européenne)-mark single-center implantation experience and short-term outcome with the second-generation transapical JenaValve transcatheter aortic valve implantation system. Patients [N = 27; 9 women; mean (SD) age, 80.3 (5.5) years] were operated on between November 2011 and August 2012. Via a transapical approach, the valve was positioned, in some cases, repositioned, and finally implanted. All data were collected during the hospital stay. The implantation success rate was 100%; the mean (SD) operation time was 124.7 (43.2) minutes; and the size of the implanted prosthesis was 23 mm (n = 6), 25 mm (n = 14), and 27 mm (n = 7). The in-hospital major adverse cardiac and cerebrovascular events were as follows: intraoperative resuscitation with subsequent aortic rupture (n = 1), postoperative hemorrhage needing revision (n = 1), myocardial infarction (n = 1), atrioventricular block needing a definitive pacemaker (n = 1), new-onset renal failure needing hemodialysis (n = 1), and stroke (n = 1). The 30-day mortality was 11.1% (n = 3). The mean (SD) intensive care unit/total stay was 2.2 (1.7)/11.7 (7.9) days. Postoperative echocardiography [day 6.7 (4.8)] revealed residual paravalvular leakage of trace to grade 1 in 12 patients (44.5%) and no leakage in 15 patients, with a mean (SD) transvalvular pressure gradient of 11.6 (5.6) mm Hg with significant reduction by 36.0 (17.7) mm Hg (P = 0.0001, Wilcoxon signed rank test). This second-generation repositionable transcatheter aortic valve implantation device could safely and successfully be implanted with a fast learning curve, significant reduction in pressure gradients, overall clinical improvement at discharge, as well as an acceptable morbidity and mortality rate in this highest-risk patient cohort.

Transcatheter mitral valve implantation (TMVI) using the Edwards FORTIS device.

Transcatheter aortic valve implantation (TAVI) has demonstrated the feasibility of treating valvular heart disease with transcatheter therapy. On the back of this success, various transcatheter concepts are being evaluated to treat other valvular disease, especially mitral regurgitation (MR). The concepts currently approved to treat MR replicate surgical mitral valve repair. However, most of them cannot eliminate MR completely. Similar to TAVI, a transcatheter mitral valve implantation may provide a valuable alternative. The FORTIS transcatheter mitral valve (Edwards Lifesciences, Irvine, CA, USA) is a self-expanding device implanted via a transapical approach. We describe our experience and early results in the first five patients treated on compassionate grounds. We also describe the details of the device, selection criteria and technical details of implantation.

Feasibility of transapical cardioscopic surgery in a pig model.

We introduced a cardioscopic surgical platform for a wide range of cardiac procedures, to address various intracardiac pathologies, through the left ventricular (LV) apex on the arrested heart. The method involves endoscopic access into the LV cavity; hence the term "transapical cardioscopic surgery (TACS)." For this proof-of-concept study, we obtained transapical access to the left ventricle in five pigs. A right minithoracotomy was used for cannulation and cardiopulmonary bypass A purse string-secured incision at the apex allows for introduction of a self-made intracavitary expander, 5 mm steerable-tip endoscopic camera as well as 5 and 3 mm endoscopic instruments. The trans-apical approach provided a good exposure and an adequate surgical field, which allowed us to perform mitral valve repair, mitral valve replacement, and aortic valve replacement. This approach also enabled excellent access and visualization for atrial ablation and intra-aortic procedures. All animals were rewarmed and weaned off bypass. The proposed transapical cardioscopic platform is feasible for major intra-cardiac procedures.

Endovascular repair of the ascending aorta in patients at high risk for open repair

Although endovascular repair has been widely adopted for treatment of descending thoracic aortic pathologies, its role in ascending aortic pathologies remains undefined. We reviewed our experience with endovascular repair of ascending aortic pathologies in patients facing high or prohibitive risk with open surgical treatment. From 2007 to 2013, 6 patients (aged 16-90 years) underwent endovascular repair (pseudoaneurysm, n=4; acute type A aortic dissection, n=2). Their records were retrospectively reviewed. All patients had extensive comorbidities or anatomic features making an open surgical approach high risk. Three cases were done on an emergency basis (aortic dissection, n=2; ruptured pseudoaneurysm, n=1). Ascending aortic access was obtained through transapical (n=4), transfemoral (n=1), and left common carotid artery (n=1) approaches. Cook Zenith TX2 (n=4), Cook EVAR iliac limb (n=1), and Amplatzer occluder (n=1) devices were used, with 3 patients requiring more than 1 stent-graft. Stent-graft lengths ranged from 55 to 81 mm; diameters ranged from 22 to 40 mm. Technical success was achieved in 5 cases (83%); 1 patient (type A dissection) had an intraoperative endoleak not amendable to further endovascular repair. In-hospital and 30-day mortalities were zero. One patient sustained a minor stroke, which reversed completely. Stay ranged from 5 to 15 days. On follow-up, 1 patient (type A dissection) had an endoleak at 12 months. Two patients died of nonaortic causes at 6 and 27 months after endovascular repair. Endovascular repair of ascending aortic pathology is feasible in patients facing high risk with open surgery, with promising early results. Technical challenges remain in adapting current endovascular technology to ascending aortic pathologies, particularly type A aortic dissection.

Open transapical approach to transcatheter paravalvular leakage closure: a preliminary experience.

Significant prosthetic paravalvular leakage (PVL) could have serious clinical consequences and impairs survival. Reoperation is associated with a high mortality rate, and transcatheter closure is a new treatment modality for high-risk patients. The goal of this study was to determine safety and midterm clinical efficacy of transcatheter PVL closure using an open transapical approach. All consecutive patients who underwent transcatheter PVL closure in our center were prospectively enrolled. Pre- and postprocedural quality of life and 6-minute walk test were ascertained. All outcomes were defined according to the Valve Academic Research Consortium-2 consensus document. In total, 37 consecutive patients (mean age 67±12 years, 65% male, logistic European System for Cardiac Operative Risk Evaluation 27±17%, Society of Thoracic Surgeons score 7±4%) with severe symptomatic PVL in mitral (81%) or aortic (19%) position underwent transcatheter PVL closure. Procedure success was 86%. Early safety at 30 days (ie, event-free survival) was 84%. The 1-year survival rate was 66%. New York Heart Association functional class and quality of life significantly improved. Clinical efficacy (ie, survival free of stroke, rehospitalization, New York Heart Association 3/4, and device-related dysfunction) was 49% at 3 months and 31% at 1 year. Moderate to severe residual PVL was associated with all-cause mortality (hazard ratio, 3.9; 95% confidence interval, 1.2-12.1; P=0.03). The open transapical approach to PVL closure in high-risk patients has a high procedural success rate with an acceptable risk of adverse outcomes. This is the first study to prove an increased functional capacity and quality of life after transapical PVL closure. Residual PVL is associated with 1-year mortality.

Review: Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) has evolved as a routine therapeutic option to treat elderly and high-risk patients with symptomatic aortic stenosis over recent years. Different prostheses with self-expandable nitinol frames or balloon expandable cobalt-chromium frames are available to be inserted by means of a retrograde transfemoral, retrograde transaortic, or an antegrade transapical approach. Current risks of TAVI include: malpositioning, particulate embolisation with subsequent stroke, vascular diseases, annular injury, or coronary obstruction, as well as the need for new onset pacemaker implantation; procedural complication rates for these remain at 5%. Second-generation valves, together with further technical developments, are expected to lead to easier and safer implantation techniques, translating into optimised outcomes for individual patients. The key to successful TAVI therapy is: joint pre-procedural indication, peri-procedural conduct, and post-procedural care of the patients by an experienced heart team.

Transthoracic Access for Transcatheter Aortic Valve Replacement: Technique Using the Edwards Sapien Retroflex Delivery System

We describe our experience using the Edwards Sapien transfemoral Retroflex 3 catheter delivery system for transcatheter aortic valve replacement through the transapical and transaortic approaches. Transthoracic transcatheter valve replacement by the transapical and transaortic approaches can be safely and effectively performed with the Retroflex 3 delivery catheter, which affords several advantages over other available delivery devices.

Abstract 364: Results of a Province-wide Field Evaluation of the Use and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Quebec Compared With the STS/ACC Registry

Background: After a review of the evidence, our cardiology evaluation unit recommended to the Quebec Ministry of Health that transcatheter aortic valve implantation (TAVI) should be used in carefully selected patients and that use and outcomes be independently monitored. Herein, we describe the first results of our province-wide field evaluation of patient and procedural characteristics and clinical outcomes and compare them with the STS/ACC TVT registry. Methods: Our trained data abstractors conducted a retrospective review of medical charts of all TAVI cases (n=96) in 6 hospitals during April-July 2013. Variables, outcomes and definitions were chosen to enable valid comparison with other registries in Canada and the USA. The evaluation protocol was created in collaboration with a scientific committee of representative interventionists and surgeons. Results: During the 4-month period, the number of TAVI patients varied from 4 to 37 across the 6 centers. Median age was 83 years (interquartile range [IQR]: 78-86) vs 84 years (IQR: 78-88) in the TVT registry. Half of Quebec TAVI patients were women, as in TVT. Documentation of an evaluation by a surgeon was found for only 58% of patients and the STS predicted risk of operative mortality was documented for only 54%. Of these, the median STS score was 6% (IQR: 4-10) compared to 7% (IQR: 5-11) in TVT where 91% of patients were evaluated by 2 surgeons. The most common vascular access approach in Quebec was transfemoral (70% vs. 64% in TVT); the transapical approach was used less in Quebec than in TVT (16% vs. 29%). While all TAVI in the TVT registry used Edwards SAPIEN XT valves, in Quebec 71% of TAVI used Edwards SAPIEN XT valves, 26% were Medtronic Corevalve and 3% were Portico valves. In-hospital mortality in Quebec was 6.3% (95% CI: 1.3-11.2) compared with 5.5% (95% CI: 5.0-6.1) in TVT. Conversion to surgery (3% vs 1%) and insertion of a new permanent pacemaker (13% vs 7%) were higher in Quebec than in TVT. TAVI patients in Quebec spent less time in intensive care (median 31 hours (IQR: 23-70) vs 46 hours (IQR: 25-77) and in hospital after TAVI (median 5 days (IQR: 3-8) vs 6 (IQR: 4-10). They were also more likely to be discharged home than patients in the TVT registry (80% vs 63%). Conclusions: Preliminary results from a province-wide TAVI registry in Quebec suggest that practice and outcomes are similar to those observed in the TVT registry. Compared with TVT, notable differences in practice were less documentation of surgical evaluation and of STS predicted mortality, less use of the transapical approach and more frequent need for a permanent pacemaker. Some differences may relate to use of a greater variety of valve types in Quebec. In-hospital mortality was similar. These results will be discussed with each TAVI team. Continued monitoring and long-term follow-up in collaboration with clinical experts are essential to promote an optimal quality of care.

Transapical mitral valved stent implantation: Enhanced survival and decreased paravalvular leakages

Background/ObjectivesThis study presents the recent results of transapical implantation of a new design of a mitral valved stent with up to three months follow-up. MethodsA self-expanding re-designed mitral valved stent was implanted via transapical approach into the beating heart of eight pigs. Echocardiographic- and hemodynamic parameters were assessed before (n=8), at 1h (n=8), at one month (n=6), at two months (n=2), and at three months (n=1) after implantation and a cardiac CT was conducted. ResultsThe stent was successfully deployed in all animals. Two animals died within the first month due to incorrect fixation force. Echocardiographic evaluation showed low gradients (3.9±1.4mmHg and 1.9±0.8mmHg across the valved stent and aortic valve) and a normal mitral annular plane systolic excursion (1.1±0.2cm) after one month. No paravalvular leakages (PVL) were detected after 1h. The pulmonary artery pressure did not increase after valved stent implantation (p≥0.106). The pulmonary capillary wedge pressure (PCWP) slightly increased to 16±3mmHg after one month (p=0.033). The left ventricular end-diastolic pressure was mildly elevated (15.8±8.6mmHg) after one month. ConclusionsSecure deployment and correct position of the valved stents were reproducibly achieved in the off-pump implantation procedure. No paravalvular leakages after 1h as well as low gradients, few stent fractures and a normal longitudinal function after one month were achieved with this newly developed and well-aligned prototype. However, a number of challenges have been identified during this study and potential for improvement has been identified.

Conventional surgery and transcatheter closure via surgical transapical approach for paravalvular leak repair in high-risk patients: results from a single-centre experience.

Paravalvular leaks (PVL) occur in up to 17% of all surgically implanted prosthetic valves. Re-operation is associated with high morbidity and mortality. Transcatheter closure via a surgical transapical approach (TAp) is an emerging alternative for selected high-risk patients with PVL. The aim of this study was to compare the in-hospital outcomes of patients who underwent surgery and TA-closure for PVL in our single-centre experience. From October 2000 to June 2013, 139 patients with PVL were treated in our Institution. All the TA procedures were performed under general anaesthesia in a hybrid operative room: in all but one case an Amplatzer Vascular Plug III device was utilized. Hundred and thirty-nine patients with PVL were treated: 122 patients (87.3%) underwent surgical treatment (68% mitral PVL; 32% aortic PVL) and 17 patients (12.2%) underwent a transcatheter closure via a surgical TAp approach (all the patients had mitral PVL; one case had combined mitral and aortic PVLs); in 35% of surgical patients and in 47% of TAp patients, multiple PVLs were present. The mean age was 62.5 ± 11 years; the Logistic EuroScore was 15.4 ± 3. Most of the patients were in New York Heart Association (NYHA) functional class III-IV (57%). Symptomatic haemolysis was present in 35% of the patients, and it was particularly frequent in the TAp (70%). Many patients had >1 previous cardiac operation (46% overall and 82% of TAp patients were at their second of re-operation). Acute procedural success was 98%. In-hospital mortality was 9.3%; no in-hospital deaths occurred in patients treated through a TAp approach. All the patients had less than moderate residual valve regurgitation after the procedure. Surgical treatment was identified as a risk factor for in-hospital death at univariate analysis (OR: 8, 95% CI: 1.8-13; P = 0.05). Overall actuarial survival at follow-up was 39.8 ± 7% at 12 years and it was reduced in patients who had >1 cardiac re-operation (42 ± 8 vs. 63 ± 6% at 9 years; P = 0.009). A transcatheter closure via a surgical TAp approach appears to be a safe and effective therapeutic option in selected high-risk patients with PVL and is associated with a lower hospital mortality than surgical treatment, in spite of higher predicted risk. Long-term survival remains suboptimal in these challenging patients.

Transcatheter aortic valve replacement: Experience with the transapical approach, alternate access sites, and concomitant cardiac repairs

Transapical transcatheter aortic valve replacement (TA-TAVR) is a viable treatment option for selected high-risk elderly patients. We analyzed the 30-day mortality and perioperative complications, focusing on the "learning curve" since our first TA procedure in 2007. We also introduce unique cases, demonstrating new possibilities for alternate access sites and concurrent cardiac interventions using the apical approach. From February 2007 to May 2013, 150 patients underwent TA-TAVR (mean age, 81.4 ± 7 years; mean Society of Thoracic Surgeons score, 9.8±3.5). We compared 2 groups (group A, n=65, procedures from February 2007 to December 2010; group B, n=85, procedures from January 2011 to May 2013). Five deaths (3.3%) occurred within 30 days, with a decrease in 30-day mortality between the 2 groups (group A, n=4, 6.2%; group B, n=1, 1.2%) that became significant at 1 year (log-rank, P=.002). Severe bleeding from the apex (group A, 4.6%; group B 4.4%) and deployment of >1 valve (group A, 7.6%; group B, 10.5%) was similar in both groups. Valve embolization was less frequent in group B (group A, 4.6%; group B, 2.4%). Postoperative complications in groups A and B included stroke (3.1% vs 0%), renal failure (9.3% vs 4.7%), and permanent pacemaker implantation (6.1% vs 5.9%). No myocardial infarctions occurred in either group. Two patients received simultaneous aortic and mitral valve implantation; 1 patient undergoing TA-TAVR also underwent distal arch and descending aorta repair; all had favorable outcomes. With a further 25 TA-TAVR since May 2013, the overall mortality is 2.9% (5/175). Although working with the fragile apical tissues in high-risk elderly patients remains a challenge, we have demonstrated a reduction in mortality and complications with increasing experience in TA-TAVR. We have successfully demonstrated novel combined procedures and uses for the transapical approach and alternate access sites, which should continue to be explored.

Predictive factors of early mortality after transcatheter aortic valve implantation: individual risk assessment using a simple score

ObjectiveDecision making for intervention in symptomatic aortic stenosis should balance the risks of surgery and of transcatheter aortic valve implantation (TAVI). We identified the factors associated with early mortality after...

Simultaneous transapical aortic and mitral valve‐in‐valve implantation for double prostheses dysfunction: Case report and technical insights

Transcatheter "Valve-in-Valve" implantation (ViV) has shown promising results in high-risk patients suffering from structural valve deterioration (SVD) of a previously implanted heart valve bioprosthesis. We present a case of a 68-year-old woman with a history of three previous cardiac operations on the aortic and mitral valve. At the time of admission she was severely symptomatic due to a simultaneous SVD of a 23 mm aortic and of a 29 mm mitral St. Jude Biocor bioprosthesis. Because of the history of several cardiac operations and to her comorbidities, the patient was considered with an extremely high surgical risk profile and was therefore scheduled for double concomitant mitral and aortic ViV. Through a trans-apical approach, the patient underwent 23 and 29 mm Edwards Sapien XT implantation in the aortic and mitral bioprosthesis, respectively. The procedure was uneventful as well as the following hospital stay. At 6-months follow-up the patient is in NYHA class I. Echocardiography shows that the aortic bioprosthesis has no leak and the mean gradient is 20 mm Hg while the mitral valve has mild leak and maximum and mean gradients are 21 and 10 mm Hg, respectively. The three main technical aspects that should be carefully considered in double concomitant ViV are: sequence of valve deployment (whether to implant the mitral or the aortic valve first), choice of access and valve sizing. In conclusion, double simultaneous trans-apical mitral and aortic ViV is technically feasible. © 2014 Wiley Periodicals, Inc.

The Odyssey of TAVR from concept to clinical reality.

On 16 April 2002, my colleagues and I performed, in an inoperable and desperately ill man with critical calcific aortic stenosis (AS), the first clinical percutaneous implantation of an aortic valve bioprosthesis. As of 2013, more than 80,000 patients have been treated; and transcatheter aortic valve replacement (TAVR), so strongly criticized by all the experts throughout the early years, continues to grow in parallel with its constant technological improvements. Transcatheter aortic valve replacement can now be recognized as a medical breakthrough. It is a revolutionary technology that meets an unfulfilled clinical need for a common disease, is validated by rigorous evidence-based studies, and is applicable worldwide. We report here the main phases of this 20-year odyssey and briefly consider the prospects of TAVR, which remains in continuous development.

INCIDENCE OF RENAL FAILURE REQUIRING HEMODIALYSIS FOLLOWING TRANSCATHETER AORITC VALVE IMPLANTATION USING EDWARDS VALVE FOR SEVERE AORTIC STENOSIS: A META-ANALYSIS OF TRANSFEMORAL VERSUS TRANSAPICAL APPROACH

Studies have shown that transfemoral approach for transcatheter aortic valve implantation (TF-TAVI) requires more contrast compared to transapical (TA-TAVI) approach during the procedure. The purpose of this meta-analysis is to compare the amount of contrast used and incidence of renal failure

First in human percutaneous implantation of a balloon expandable transcatheter heart valve in a severely stenosed native mitral valve

Transcatheter implantation of a balloon expandable valve in calcified severely stenosed native mitral valves has recently been described. The two cases reported so far utilized the surgical transapical approach generally used for transapical transcatheter aortic valve replacement. A percutaneous approach has not been published. We report the first successful percutaneous implantation of a balloon expandable transcatheter valve in the native mitral valve without a surgical incision.

Effect of gender differences on 1-year mortality after transcatheter aortic valve implantation for severe aortic stenosis: results from a multicenter real-world registry

The aim of this analysis is to examine the influence of gender differences on the outcome after transcatheter aortic valve implantation (TAVI) from a multicenter real-world registry in Germany (TAVI registry). The impact of gender differences on the clinical outcome after TAVI was examined in small studies with conflicting results. Consecutive patients (n = 1,432) undergoing TAVI in the period between January 2009 and June 2010 in Germany were evaluated. Differences in all-cause mortality were examined with Kaplan-Meier estimates and proportional hazards models. Women comprised 57.8 % of the cohort. The Edwards Sapien valve (18.5 %) and CoreValve (81.5 %) were used through the transfemoral (87.7 %), subclavian (3.0 %), transapical (8.6 %), or transaortic approach (0.7 %). At baseline, women had higher aortic gradients and were older. Men had more comorbidities: prior myocardial infarction, prior revascularization, prior coronary artery bypass surgery, peripheral arterial vascular disease and chronic obstructive pulmonary disease. Women had more periprocedural vascular complications in comparison to men (25.2 vs. 17.2 %, p < 0.001). There was no significant difference in mortality at 30-day follow-up (7.6 % for women vs. 8.6 % for men, p = 0.55). The adjusted HR for 1-year all-cause mortality favored women, HR 0.75 (95 % CI 0.57-0.98, p = 0.0346) with a mortality rate of 17.3 vs. 23.6 % for men. Female gender is associated with better 1-year survival after TAVI. These results suggest that TAVI could be the best treatment modality for elderly women with symptomatic severe aortic stenosis.