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

Abstract

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.

Preoperative Frailty Assessment and Outcomes at 6 Months or Later in Older Adults Undergoing Cardiac Surgical Procedures

“…Ewe et al(59) found that frailty phenotype was statistically significantly associated with a 4.2-fold risk in mortality or MACCE, whereas Munoz-Garcia et al(51) did not find such association, likely due to overadjustment for post-procedure ADL dependence. Frailty defined by all other instruments (11, 14, 58, 61) was statistically significantly associated with a 1.9- to 5.6-fold risk in mortality. Only the Green index(14) was developed in a highly representative sample (Appendix Figure 2 panel A).…”

“…We identified 25 studies that evaluated the association of frailty with mortality or functional status at ≥6 months in 18388 patients undergoing major cardiac surgical procedures (9 frailty instruments in 8 studies of CABG or open valve surgery)(41-49) and 5177 patients undergoing minimally invasive cardiac surgical procedures (13 instruments in 17 studies of TAVR)(11-15, 50-61) (Appendix Figure 1). …”

Does mild paravalvular regurgitation post transcatheter aortic valve implantation affect survival? A meta‐analysis

“…Our initial literature search resulted in total of 3,447 articles. A total of 25 articles [3,[6][7][8][9][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] including total of 21,018 patients were finally included for quantitative synthesis (meta-analysis). Detailed study selection flow is summarized in Supporting Information 1.…”

Simulated transcatheter aortic valve deformation: A parametric study on the impact of leaflet geometry on valve peak stress

“…In addition, there has been a recent trend toward a more extensive use of TAV devices in patients with an intermediate to high-risk profile [14]. Although significant experience has been gained and outcomes of TAV implantations are encouraging with a 3-year survival rate of 71.6% [15], various periprocedural complications such as acute kidney injury, vascular complications, pacemaker implantation, paravalvular regurgitation, and major bleeding have been reported [4, 12, 15-17]. Furthermore, due to more constraints on TAV leaflets [18], the long-term durability and safety of TAV devices need to be evaluated and studied carefully [19-21].…”