Long-Term Outcomes After Transcatheter Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is as an alternative treatment to surgical AVR, but the long-term outcomes of TAVR remain unclear. This study aimed to analyze long-term outcomes following TAVR using meta-analysis. Methods: A literature search was performed with MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar through December 2022; studies reporting clinical outcomes of TAVR with follow-up periods of {greater than or equal to} 8 years were included. The outcomes of interest were overall survival and/or freedom from structural valve deterioration (SVD). Surgical risk was assessed with the Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. A subgroup analysis was conducted for intermediate-/high-surgical risk patients only. Results: Eleven studies including 5,458 patients were identified and analyzed. The mean age was 82.0 {plus minus} 6.5 years, and mean STS PROM score ranged from 2.9 to 10.6%. Survival rate at 5 and 10 years was 47.7% {plus minus} 1.4% and 12.1 {plus minus} 2.0%. Five studies including 1,509 patients were analyzed for SVD. Freedom from SVD at 5 and 8 years was 95.5 {plus minus} 0.7% and 84.9 {plus minus} 3.1%. Similar results for survival and SVD were noted in the subgroup analysis of intermediate-/high-risk patients. Conclusions: Following TAVR, approximately 88% of patients died within 10 years, whereas 85% were free from SVD at 8 years. These date suggest that baseline patient demographic have the greatest impact on survival, and SVD does not seem to have a prognostic impact in this population. Further investigations on longer-term outcomes of younger and lower-risk patients are warranted.