Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: the U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry.
OBJECTIVE
The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term.


BACKGROUND
Although a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.


METHODS
The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010.


RESULTS
Survival at 30 days was 92.9%, and it was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.


CONCLUSIONS
Midterm to long-term survival after TAVI was encouraging in this high-risk patient population, although a substantial proportion of patients died within the first year.
Royal Brompton and Harefield National Health Service (NHS) Foundation Trust, London, United Kingdom. n.moat@rbht.nhs.uk
Neil E
NE
Moat
Peter
P
Ludman
Mark A
MA
de Belder
Ben
B
Bridgewater
Andrew D
AD
Cunningham
Christopher P
CP
Young
Martyn
M
Thomas
Jan
J
Kovac
Tom
T
Spyt
Philip A
PA
MacCarthy
Olaf
O
Wendler
David
D
Hildick-Smith
Simon W
SW
Davies
Uday
U
Trivedi
Daniel J
DJ
Blackman
Richard D
RD
Levy
Stephen J D
SJ
Brecker
Andreas
A
Baumbach
Tim
T
Daniel
Huon
H
Gray
Michael J
MJ
Mullen
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology