Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Abstract

Background: Transcatheter aortic valve implantation/replacement (TAVI/TAVR) is becoming more frequently used to treat aortic stenosis (AS), with increasing push for the procedure in lower risk patients.Numerous randomized controlled trials have demonstrated that TAVI offers a suitable alternative to the current gold standard of surgical aortic valve replacement (SAVR) in terms of short-term outcomes. The present review evaluates long-term outcomes following TAVI procedures.Methods: Literature search using three electronic databases was performed up to June 2017. Studies which included 20 or more patients undergoing TAVI procedures, either as a stand-alone or concomitant procedure and with a follow-up of at least 5 years, were included in the present review. Literature search and data extraction were performed by two independent researchers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and subsequently aggregated for analysis.Results: Thirty-one studies were included in the present analysis, with a total of 13,857 patients. Two studies were national registries, eight were multi-institutional collaborations and the remainder were institutional series. Overall, 45.7% of patients were male, with mean age of 81.5±7.0 years. Where reported, the mean Logistic EuroSCORE (LES) was 22.1±13.7 and the mean Society of Thoracic Surgeons (STS) score was 9.2±6.6. The pooled analysis found 30-day mortality, cerebrovascular accidents, acute kidney injury (AKI) and requirement for permanent pacemaker (PPM) implantation to be 8.4%, 2.8%, 14.4%, and 13.4%, respectively. Aggregated survival at 1-, 2-, 3-, 5-and 7-year were 83%, 75%, 65%, 48% and 28%, respectively. Conclusions:The present systematic review identified acceptable long-term survival results for TAVI procedures in an elderly population. Extended follow-up is required to assess long-term outcomes following TAVI, particularly before its application is extended into wider population groups. Ann Cardiothorac Surg 2017;6(5):432-443 www.annalscts.com IntroductionAs Western populations age, the prevalence of aortic stenosis (AS) is gradually increasing (1). In a select population, surgical aortic valve replacement (SAVR) is precluded by patient frailty and other comorbidities (2). The availability of transcatheter aortic valve implantation/ replacement (TAVI/TAVR), pioneered in the early 2000s, has made a significant impact on survival for these patients (3-5). These early successes led to a number of trials, such as the PARTNER and US Pivotal trials, which compared TAVI, SAVR and standard treatment outcomes ( Figure 1). As a result, TAVI is increasingly being considered as a less-invasive option for treatment of AS in younger and lower surgical risk patients, where SAVR is not necessarily contraindicated (6,7), although this is not without controversy (8).While the short-term outcomes of TAVI have been well explored, limited studies have examined longer term results (9,10). Additiona...

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

“…A report from 5-year follow-up from PARTNER I trial revealed excellent durability without significant structural valve degeneration up to 5 years [24]. A meta-analysis confirmed the good long-term durability of TAVR devices [25]. However, the long-term durability is of pivotal importance in younger patient with a life-expectance greater than 10 years when TAVR or SAVR options are considered.…”

Surgical aspects and results of a single-center prospective register of transcatheter aortic valve implantation

“…Так, во французском регистре PMSI, включившем 1332 пациента, частота летальных исходов на госпитальном этапе составила 7,9% [12]. В регистре Swiss TAVI данный показатель составил 4,8% [13]. Различия в летальности могут объясняться как характеристикой пациентов (сопутствующая патология и так называемый индекс "дряхлости"), так и особенностями процедуры (операционный доступ, тип имплантируемого протеза).…”

Custo-Efetividade No Tratamento De Estenose Valvar Aórtica: Um Estudo Das Técnicas Bav E Tavi

“…Os resultados clínicos no curto prazo são satisfatórios (MCRAE; RODGER, 2012) e a melhora na qualidade de vida é significativa (WONG; GREEN; WILLIAMS, 2013). Apesar de ainda ser necessária a consolidação dos resultados clínicos do TAVI em médio e longo prazo, alguns estudos já têm constatado bons índices de sobrevida entre o terceiro e quarto ano após o tratamento em pacientes idosos (CHAKOS et al, 2017; KOURKOVELI; SPARGIAS; HAHALIS, 2018).…”