Usefulness of Percutaneous Aortic Valve Implantation to Improve Quality of Life in Patients >80 Years of Age Raffi Bekeredjian, MD a, * ,† , Ulrike Krumsdorf, MD a,† , Emanuel Chorianopoulos, MD a , Klaus Kallenbach, MD b , Mathias Karck, MD b , Hugo Albert Katus, MD a , and Wolfgang Rottbauer, MD a Older patients with aortic stenosis cannot always be offered conventional surgical aortic valve replacement at an acceptable risk. Transcatheter aortic valve implantation (TAVI) is currently considered an alternative treatment option with lower periprocedural risks. However, its effect on post-TAVI quality of life and clinical improvement has not been systematically and prospectively evaluated in those of advanced age. Thus, the aim of the present study was to assess the clinical improvement in geriatric patients after TAVI, with a special emphasis on quality of life. In the present study, we assessed the quality of life and brain natriuretic peptide in patients aged >80 years, before and 6 months after transfemo- ral CoreValve implantation. Of 87 prospectively studied patients with severe, symptomatic aortic stenosis at an age of >81 years, 80 survived for 6 months and were able to attend the follow-up visit with a quality of life assessment, using the Medical Outcomes Trust Short Form 36-Item Health Survey (average age 86  2.9 years). The average scores of all 8 health components had improved significantly after TAVI. The greatest gain was seen in physical functioning (improvement from 23.4  6.0 to 67.8  13.7; p <0.001). The lowest gain was seen in bodily pain (improved from 37.5  9.4 to 51.3  11.5; p <0.05). Similarly, both the physical and the mental component summary scores improved significantly. This was consistent with significant improvement in brain natriuretic peptide levels (5,770  8,016 to 1,641  3,650 ng/L; p <0.0001). In conclusion, the results of the present study have shown a significant clinical benefit from TAVI in a patient population aged >81 years. © 2010 Elsevier Inc. All rights reserved. (Am J Cardiol 2010;106:1777–1781) In high-risk patients with severe aortic stenosis, trans- catheter aortic valve implantation (TAVI) offers a good alternative to medical therapy. 1–7 Many eligible patients for this procedure are of advanced age and require a more specific characterization of postprocedural success. In the present study, we assessed, for the first time, the quality of life of patients aged 80 years, before and 6 months after transfemoral CoreValve implantation, using the Medical Outcomes Trust Short Form 36-Item Health Survey. 8 –12 In addition, we measured the N-terminal pro-brain natriuretic peptide levels. Methods From July 2008 to January 2010, 108 consecutive patients were treated with transfemoral CoreValve im- plantation at our institution. All patients had symptom- atic aortic stenosis with an orifice area of 1 cm 2 and were considered high-risk surgical patients with either a logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) 13 of 20% or specific co-mor- bidities that would exclude surgical therapy, such as porce- lain aorta, chest radiotherapy, or a severely reduced lung capacity. In addition, the risk score of the Society of Tho- racic Surgeons was calculated for each patient. Before TAVI, all patients underwent heart catheterization to iden- tify relevant coronary artery disease that would be treated by stenting. Furthermore, the patients underwent transtho- racic echocardiography, and electrocardiographic-gated 256-slice cardiac computed tomography (Brilliance iCT, Philips Medical Systems, Best, The Netherlands) of the heart and computed tomographic angiography of the ab- dominal aorta and pelvic and femoral arteries. The main exclusion criteria for percutaneous aortic valve implantation were an aortic annulus diameter of 19 or 27 mm and access artery diameters of 6 mm. Of these 108 patients, 87 were 80 years old (85  2.7 years). All patients were informed of the specific risks and alternatives of TAVI and gave informed written consent for TAVI and pre- and postinterventional monitoring (data collection). The study protocol was in accordance with the local ethics committee guidelines. All transfemoral aortic valve implantations were per- formed using the 18Fr CoreValve device (Medtronic, Min- neapolis, Minnesota), as previously described. 3,5 In brief, first an 18Fr delivery sheath was placed into the femoral artery, a transjugular pacemaker was placed into the right ventricle, and balloon valvuloplasty was performed under Departments of a Cardiology and b Cardiothoracic Surgery, University of Heidelberg, Heidelberg, Germany. Manuscript received July 2, 2010; manuscript received and accepted August 11, 2010. *Corresponding author: Tel: (+49) 0-6221-563-9097; fax: (+49) 0-6221-56-5515. E-mail address: raffi.bekeredjian@med.uni-heidelberg.de (R. Bekered- jian). † Drs. Bekeredjian and Krumsdorf contributed equally. 0002-9149/10/$ – see front matter © 2010 Elsevier Inc. All rights reserved. www.ajconline.org doi:10.1016/j.amjcard.2010.08.017