Clinical Research
Interventional Cardiology
5-Year Outcome After Transcatheter Aortic Valve Implantation

https://doi.org/10.1016/j.jacc.2012.11.010Get rights and content
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Objectives

The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI).

Background

Little is known about long-term outcomes following TAVI.

Methods

The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded.

Results

Mean aortic valve gradient decreased from 46 ± 18 mm Hg to 10 ± 4.5 mm Hg after TAVI and 11.8 ± 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 ± 0.17 cm2 to 1.67 ± 0.41 cm2 after TAVI and 1.40 ± 0.25 cm2 at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction (moderate transvalvular regurgitation in 1, moderate stenosis in 1, and moderate mixed disease in 1). Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years (95% confidence interval [CI]: 2.6 to 4.3), and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (adjusted hazard ratio [HR]: 2.17; 95% CI: 1.28 to 3.70) and at least moderate paravalvular regurgitation (adjusted HR: 2.98; 95% CI: 1.44 to 6.17).

Conclusions

Our study demonstrated favorable long-term outcomes after TAVI. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, notably chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival.

Key Words

aortic stenosis
aortic valve
bleeding
long-term outcome
transcatheter aortic valve implantation
transcatheter aortic valve replacement

Abbreviations and Acronyms

COPD
chronic obstructive pulmonary disease
MR
mitral regurgitation
PAR
paravalvular regurgitation
SAVR
surgical aortic valve replacement
TAVI
transcatheter aortic valve implantation
THV
transcatheter heart valve

Cited by (0)

Drs. Toggweiler and Binder are supported by a grant from the Swiss National Foundation. Drs. Binder, Cheung, Moss, Rodés-Cabau, Webb, Wood, and Ye are consultants to Edwards Lifesciences.

All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.