title: Long-term outcomes after transcatheter aortic valve replacement in high-risk patients with severe aortic stenosis: the U.K. Transcatheter Aortic Valve Implantation Registry.
abstract: OBJECTIVE
  The U.K. Transcatheter Aortic Valve Implantation Registry reported 30-day and 1-year mortality rates of 7.1% and 21.4%, respectively, for patients who underwent transcatheter aortic valve replacement (TAVR) in the United Kingdom between 2007 and 2009. The study aim was to report long-term outcomes in this same cohort of patients.
  
  
  BACKGROUND
  There are few data on outcomes beyond 3 years after TAVR in any notable number of patients.
  
  
  METHODS
  Data from all TAVR procedures performed in the United Kingdom between January 2007 and December 2009 were prospectively collected. All-cause mortality status was reported in March 2014. Mortality tracking was achieved in 97.7% patients.
  
  
  RESULTS
  The minimal time from replacement to census was 4.1 years, and the maximal time was 7.0 years. The 3- and 5-year survival rates were 61.2% and 45.5%, respectively. Independent predictors of 3-year mortality were renal dysfunction (hazard ratio [HR]: 1.65), atrial fibrillation (HR: 1.36), logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥18.5 (HR: 1.33), respiratory dysfunction (HR: 1.28), and ventricular dysfunction (left ventricular ejection fraction <30%) (HR: 1.53). Coronary artery disease (HR: 1.28) and age (HR: 1.03) were additional independent predictors of mortality at 5 years. Stroke within 30 days of TAVR was the only independent procedural predictor of mortality at 3 and 5 years (HR: 2.17 at 3 years). Device type, access route, and paravalvular leak did not independently predict long-term outcome.
  
  
  CONCLUSIONS
  In the large U.K. Transcatheter Aortic Valve Implantation Registry, long-term outcomes after TAVR are favorable with 3- and 5-year survival rates of 61.2% and 45.5%, respectively. Long-term survival after TAVR is largely determined by intrinsic patient factors. Other than stroke, procedural variables, including paravalvular aortic leak, did not appear to be independent predictors of long-term survival.
authors.affiliation: Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom.
authors.forename: Alison
authors.initials: A
authors.lastname: Duncan
authors.affiliation: Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Ludman
authors.affiliation: Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom.
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.affiliation: National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom.
authors.forename: Damian
authors.initials: D
authors.lastname: Marlee
authors.affiliation: Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Davies
authors.affiliation: University College London, Institute of Cardiovascular Science, London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.affiliation: University Hospital Leicester, Leicester, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Kovac
authors.affiliation: University Hospital Leicester, Leicester, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spyt
authors.affiliation: Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom. Electronic address: n.moat@rbht.nhs.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Moat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D002423:Cause of Death; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: UK-TAVI Registry; long-term outcome; predictors of survival; transcatheter valve replacement