Abstract
The durability of transcatheter heart valves and long-term clinical outcomes are unknown. The aim of this study was to evaluate clinical and hemodynamic outcomes between 5 to 9 years after Transcatheter Aortic Valve Implantation (TAVI).
Methods
Between April 2008 and December 2012, 305 patients underwent TAVI for the treatment of severe symptomatic aortic stenosis with the auto-expandable prosthesis.
Results
The mean age, logistic EuroSCORE and STS score were 79.3±6.5 years, 19.4±12% and 6.6±4% respectively. Mean aortic valve gradient decreased from 48.7±15 mm Hg to 8.9±4.3 mmHg after TAVI, to 11.1±9 mm Hg at 4 years, and 22.7±12 mmHg at 5 years (p for post-TAVI trend 0.03). Mean aortic valve area increased from 0.63±0.16 cm2 to 1.57±0.3cm2 after TAVI to 1.48±0.2 at 4 years and 0.97±0.3 cm2 at 5 years (p for post-TAVI trend 0.01). Mean left ventricular ejection fraction increased from 61.1±15% to 65.5±11% after TAVI, to 58.2±17% at 4 years and 60.7±8% at 5 years (p for post-TAVI trend 0.001).
Late mortality after a mean of 4.15±2.4 years 58% and in only 34.1% patients was cardiovascular mortality. Survival rates at 1 to 9 years were at 87.5%, 79%, 73.1%, 65.6%, 55.4%, 48.2%, 41.9%, 37.3% and 35.1% respectively. At 5 years, 3 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitation). Median survival time after TAVI was 6 years (95% confidence interval [CI]: 5.89 to 6.28), and the risk of death was significantly increased in patients with frailty (adjusted hazard ratio [HR]: 1.864; 95% CI: 1.204 to 2.886), p=0.001, Charlson index [HR= 1.243 (95% CI 1.148–1.346), p<0.001], and left ventricular ejection fraction [HR= 1.012; (95% CI 1.001–1.024)p=0.044].
Conclusions
Our study demonstrated favorable long-term outcomes after TAVI. Signs of prosthetic valve failure were observed in 0.97% of patients
Long‐Term Outcomes in Patients With Mixed Aortic Valve Disease and Preserved Left Ventricular Ejection Fraction
