Long-Term TAVI Outcomes Reported From UK Registry

May 1, 2015—Long-term outcomes in the United Kingdom (UK) Transcatheter Aortic Valve Implantation registry were reported by Alison Duncan, MD, et al in the Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2015;8:645–653). 

There are few data on outcomes beyond 3 years after transcatheter aortic valve replacement (TAVR) in any notable number of patients, noted the investigators in the study's background. Previously, the registry reported 30-day and 1-year mortality rates of 7.1% and 21.4%, respectively, for patients who underwent TAVR in the United Kingdom between 2007 and 2009. 

The investigators concluded that in the large UK Transcatheter Aortic Valve Implantation registry, long-term outcomes after TAVR are favorable with 3- and 5-year survival rates of 61.2% and 45.5%, respectively. They found that long-term survival after TAVR is largely determined by intrinsic patient factors. Other than stroke, procedural variables (including paravalvular aortic leak) did not appear to be independent predictors of long-term survival, reported the investigators in JACC: Cardiovascular Interventions.

The investigators prospectively collected data from all TAVR procedures performed in the United Kingdom between January 2007 and December 2009. All-cause mortality status was reported in March 2014. Mortality tracking was achieved in 97.7% patients.

As summarized in JACC: Cardiovascular Interventions, the minimal time from replacement to census was 4.1 years, and the maximal time was 7 years. The 3- and 5-year survival rates were 61.2% and 45.5%, respectively. 

Independent predictors of 3-year mortality were renal dysfunction, atrial fibrillation, logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 18.5, respiratory dysfunction, and ventricular dysfunction (left ventricular ejection fraction < 30%). Coronary artery disease and age were additional independent predictors of mortality at 5 years. Stroke within 30 days of TAVR was the only independent procedural predictor of mortality at 3 and 5 years. Device type, access route, and paravalvular leak did not independently predict long-term outcome, advised the investigators in JACC: Cardiovascular Interventions.