Long-term outcomes after transcatheter aortic valve replacement in high-risk patients with severe aortic stenosis: the U.K. Transcatheter Aortic Valve Implantation Registry

Alison Duncan; Peter Ludman; Winston Banya; David Cunningham; Damian Marlee; Simon Davies; Michael Mullen; Jan Kovac; Thomas Spyt; Neil Moat

doi:10.1016/j.jcin.2015.01.009

Long-term outcomes after transcatheter aortic valve replacement in high-risk patients with severe aortic stenosis: the U.K. Transcatheter Aortic Valve Implantation Registry

JACC Cardiovasc Interv. 2015 Apr 27;8(5):645-53. doi: 10.1016/j.jcin.2015.01.009.

Authors

Affiliations

¹ Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom.
² Queen Elizabeth Hospital, Birmingham, United Kingdom.
³ National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom.
⁴ University College London, Institute of Cardiovascular Science, London, United Kingdom.
⁵ University Hospital Leicester, Leicester, United Kingdom.
⁶ Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom. Electronic address: [email protected].

PMID: 25946435
DOI: 10.1016/j.jcin.2015.01.009

Abstract

Objectives: 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.

Keywords: UK-TAVI Registry; long-term outcome; predictors of survival; transcatheter valve replacement.

MeSH terms

Aged
Aged, 80 and over
Aortic Valve Stenosis / diagnosis
Aortic Valve Stenosis / mortality
Aortic Valve Stenosis / therapy*
Aortic Valve*
Cardiac Catheterization* / adverse effects
Cardiac Catheterization* / instrumentation
Cardiac Catheterization* / mortality
Cause of Death
Female
Heart Valve Prosthesis Implantation* / adverse effects
Heart Valve Prosthesis Implantation* / instrumentation
Heart Valve Prosthesis Implantation* / mortality
Humans
Kaplan-Meier Estimate
Logistic Models
Male
Multivariate Analysis
Proportional Hazards Models
Registries
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke / etiology
Stroke / mortality
Time Factors
Treatment Outcome
United Kingdom