Long Term Outcomes of Patients Treated With Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology 2021-02, Vol.141, p.72-78
• Main Authors: Schamroth Pravda, Nili, Codner, Pablo, Vaknin Assa, Hana, Witberg, Guy, Assali, Abid, Orvin, Katia, Hamdan, Ashraf, Belosesky, Yichayaou, Barsheshet, Alon, Sharoni, Ram, Soudry, Omri, Perl, Leor, Shapira, Yaron, Sagie, Alik, Kornowski, Ran
• Format: Article
• Language: English
• Subjects: Access routes; Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic Valve Disease - epidemiology; Aortic Valve Stenosis - surgery; Balloon treatment; Cause of Death; Clinical outcomes; Durability; Female; Heart Valve Prosthesis; Heart valves; Hemodynamics; Humans; Implantation; Longitudinal Studies; Male; Mortality; Patients; Postoperative Complications - epidemiology; Prosthesis Failure; Registries; Stenosis; Transcatheter Aortic Valve Replacement - methods; Transplants & implants; Trends
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.11.007

•Transcatheter Aortic Valve Implantation patients have a favorable long-term outcome.•Valve hemodynamic were maintained on follow up.•Procedural aspects and outcomes have improved over time. Transcatheter aortic-valve implantation (TAVI) is an established treatment option in patients with severe symptomatic aortic stenosis. Intermediate and long-term follow up data of these patients is limited. Data was taken from a large all-comer single center prospective registry (2008 to 2019). The primary end point was all-cause mortality. The secondary endpoints were long-term valve hemodynamic performance; paravalvular leak (PVL) at 5-year follow-up. We also report on temporal trends in this cohort. Our cohort included 998 patients with a mean age of 82.3 ± 7.2 years and 52.2% females. TAVI was performed via the transfemoral, trans-apical, subclavian and other access routes in 93.9%, 3.6%, 2.5%, and 0.6% of patients, respectively. A self-expandable device was used in 69.4% of cases, balloon expandable device in 28.1% and in 2.5% other devices. The cumulative risk for all-cause mortality at 5 years was 43.4% (95% CI 39.1 to 47.7). The immediate and long-term valve gradients were low and maintained. On durability analysis at 5 years, severe structural valve deterioration was present in 1.6% of cases. At 5-year follow-up, PVL was moderate in 3.3% and no patients has severe PVL. On temporal trends analysis, we found that the procedural aspects of TAVI improved over time with lower rates of significant PVL and significantly lower procedural mortality. In conclusion, TAVI patients have a favorable long-term outcome, with excellent valve hemodynamic parameters and good clinical outcomes. Over time and with increasing experience, procedural and patient outcomes have improved.