Long-Term Outcomes for Patients With Severe Symptomatic Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology Vol. 116; no. 9; pp. 1391 - 1398
• Main Authors: Codner, Pablo, MD, Orvin, Katia, MD, Assali, Abid, MD, Sharony, Ram, MD, Vaknin-Assa, Hanna, MD, Shapira, Yaron, MD, Schwartzenberg, Shmuel, MD, Bental, Tamir, MD, Sagie, Alexander, MD, Kornowski, Ran, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2015; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - mortality; Aortic Valve Stenosis - surgery; Cardiology; Cardiovascular; Classification; Confidence intervals; Consortia; Female; Follow-Up Studies; Frailty; Gender; Heart attacks; Heart Valve Prosthesis; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Medical imaging; Medical prognosis; Mortality; Multivariate analysis; Patients; Prostheses; Prosthesis Design; Retrospective Studies; Risk Factors; Severity of Illness Index; Studies; Survival analysis; Time Factors; Transcatheter Aortic Valve Replacement - instrumentation; Transcatheter Aortic Valve Replacement - methods; Transcatheter Aortic Valve Replacement - mortality; Treatment Outcome; Variables
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.08.004

Transcatheter aortic valve implantation (TAVI) is an established technique for the treatment of severe symptomatic aortic stenosis. Data on long-term TAVI outcomes, both hemodynamic and clinical, in real-world practice settings are limited. We aim to explore the long-term clinical results in patients with severe symptomatic aortic stenosis using multiple catheter-based options: 360 TAVI-treated patients were followed up for ≤5 years. The Medtronic CoreValve was used in 71% and the Edwards SAPIEN in 26%. The primary end point was all-cause mortality during follow-up. Outcomes were assessed based on the Valve Academic Research Consortium 2 criteria. The mean ± SD patient age was 82.1 ± 6.9 years (56.4% women). The Society of Thoracic Surgeons score was 7.5 ± 4.7. The clinical efficacy end point and time-related valve safety at 3 years was 50% and 81.7%, respectively. The calculated 3- and 5-year survival rates were 71.6% and 56.4%, respectively. Five-year follow-up data were obtained for 54 patients alive; 96.2% of alive patients were in the New York Heart Association class I and II, 4 years after TAVI. No gender differences in all-cause mortality rates were observed (p = 0.58). In multivariate analysis, hospitalization 6 months previous to TAVI (hazard ratio [HR] 1.92, 95% confidence interval [CI] 1.17 to 3.15, p = 0.01), frailty (HR 1.89, 95% CI 1.11 to 3.2, p = 0.02), acute kidney injury (HR 1.93, 95% CI 1.03 to 3.61, p = 0.04), and moderate or more paravalvular aortic regurgitation after TAVI (HR 4.26, 95% CI 2.54 to 7.15, p <0.001) were independent predictors for all-cause mortality. In conclusion, long-term outcomes of TAVI are encouraging. Prevention and early identification of paravalvular leak and acute renal failure after the procedure would improve short- and long-term outcomes.