Long-Term Outcomes for Patients With Severe Symptomatic Aortic Stenosis Treated With Transcatheter Aortic Valve Implantation.
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.
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pablo
P
Codner
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Katia
K
Orvin
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Abid
A
Assali
"Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel; Cardiothoracic Surgery Department, Rabin Medical Center, Petah Tikwa, Israel.
Ram
R
Sharony
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Hanna
H
Vaknin-Assa
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Yaron
Y
Shapira
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Shmuel
S
Schwartzenberg
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Tamir
T
Bental
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Alexander
A
Sagie
Cardiology Department, Rabin Medical Center, Petah Tikwa, Israel; "Sackler" School of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: ran.kornowski@gmail.com.
Ran
R
Kornowski
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D016896:Treatment Outcome