Long-term outcomes after transcatheter aortic valve implantation: insights on prognostic factors and valve durability from the Canadian multicenter experience.
OBJECTIVE
This study sought to evaluate the long-term outcomes after transcatheter aortic valve implantation (TAVI) in the Multicenter Canadian Experience study, with special focus on the causes and predictors of late mortality and valve durability.


BACKGROUND
Very few data exist on the long-term outcomes associated with TAVI.


METHODS
This was a multicenter study including 339 patients considered to be nonoperable or at very high surgical risk (mean age: 81 ± 8 years; Society of Thoracic Surgeons score: 9.8 ± 6.4%) who underwent TAVI with a balloon-expandable Edwards valve (transfemoral: 48%, transapical: 52%). Follow-up was available in 99% of the patients, and serial echocardiographic exams were evaluated in a central echocardiography core laboratory.


RESULTS
At a mean follow-up of 42 ± 15 months 188 patients (55.5%) had died. The causes of late death (152 patients) were noncardiac (59.2%), cardiac (23.0%), and unknown (17.8%). The predictors of late mortality were chronic obstructive pulmonary disease (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.53 to 3.11), chronic kidney disease (HR: 1.08 for each decrease of 10 ml/min in estimated glomerular filtration rate, 95% CI: 1.01 to 1.19), chronic atrial fibrillation (HR: 1.44, 95% CI: 1.02 to 2.03), and frailty (HR: 1.52, 95% CI: 1.07 to 2.17). A mild nonclinically significant decrease in valve area occurred at 2-year follow-up (p < 0.01), but no further reduction in valve area was observed up to 4-year follow-up. No changes in residual aortic regurgitation and no cases of structural valve failure were observed during the follow-up period.


CONCLUSIONS
Approximately one-half of the patients who underwent TAVI because of a high or prohibitive surgical risk profile had died at a mean follow-up of 3.5 years. Late mortality was due to noncardiac comorbidities in more than one-half of patients. No clinically significant deterioration in valve function was observed throughout the follow-up period.
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. josep.rodes@criucpq.ulaval.ca
Josep
J
Rodés-Cabau
John G
JG
Webb
Anson
A
Cheung
Jian
J
Ye
Eric
E
Dumont
Mark
M
Osten
Christopher M
CM
Feindel
Madhu K
MK
Natarajan
James L
JL
Velianou
Giussepe
G
Martucci
Benoît
B
DeVarennes
Robert
R
Chisholm
Mark
M
Peterson
Christopher R
CR
Thompson
David
D
Wood
Stefan
S
Toggweiler
Ronen
R
Gurvitch
Samuel V
SV
Lichtenstein
Daniel
D
Doyle
Robert
R
DeLarochellière
Kevin
K
Teoh
Victor
V
Chu
Kevin
K
Bainey
Kevin
K
Lachapelle
Asim
A
Cheema
David
D
Latter
Jean G
JG
Dumesnil
Philippe
P
Pibarot
Eric
E
Horlick
D000368:Aged; D000369:Aged, 80 and over; D002170:Canada / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000401:mortality / Q000639:trends*; D004867:Equipment Design / Q000401:mortality / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000639:trends*; D006801:Humans; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography