Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry

Study Questions:

What are the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and their clinical outcome over the mid- to long-term?

Methods:

The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010. Time-to-event data analysis was done using the Cox proportional hazards model. The Kaplan-Meier survival curves were drawn to assess differences between groups for the time to an event data.

Results:

Survival at 30 days was 92.9%, and was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.

Conclusions:

The authors concluded that the mid- to long-term survival after TAVI was encouraging in this high-risk patient population.

Perspective:

This national, multicenter registry of a large consecutive and all-inclusive series of patients diagnosed with severe symptomatic aortic stenosis who underwent TAVI reports acceptable 30-day mortality, but a significant attrition between 30 days and 12 months, predominantly in the highest risk cohort. The data in this registry provide support for TAVI in high-risk or inoperable patients, when performed in properly designated centers with adequately trained personnel. It is critical for TAVI centers to have a multidisciplinary “valve team” for optimal patient selection, careful training and credentialing of performing physicians, and continued outcome assessment by being part of randomized studies and/or good-quality registries.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease

Keywords: Survivors, Heart Valve Prosthesis, Pulmonary Disease, Chronic Obstructive, Great Britain, Coronary Artery Disease, Kaplan-Meier Estimate, Credentialing, Ventricular Function, Left, Coronary Disease, Heart Valve Prosthesis Implantation


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