Transcatheter Aortic Valves Provide Long-Term Stability; Mortality Remains High

New registry data, released on Oct. 10 in the Journal of the American College of Cardiology, indicate that balloon-expandable aortic valves maintain functional and hemodynamic stability over the long term, but patients undergoing transcatheter aortic valve implantation (TAVI) suffer high long-term mortality.

The results, are based on 339 consecutive patients enrolled in the Canadian TAVI Multicenter Registry who underwent TAVI with balloon-expandable Edwards valves between 2005 and 2009 in six Canadian centers. They show that at a mean follow-up of 42±15 months, 55.5 percent of patients had died. Of these patients, 10.4 percent suffered cardiac deaths within 30 days of TAVI. Another 44.8 percent of patients died during the follow-up period. The majority of these deaths — 59.2 percent — were noncardiac, with the most frequent cause being pulmonary failure. Another 23 percent of deaths during the follow-up period were attributed to cardiac causes, and 17.8 percent were of unknown causes.

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On multivariate analysis, chronic obstructive pulmonary disease, chronic kidney disease, chronic atrial fibrillation and frailty were significant predictors of long-term mortality. Echocardiographic studies demonstrated a small, non-clinically significant decrease in valve area at two-year follow-up, but there were no changes in residual aortic regurgitation and no reports of structural valve failure.

According to the study authors, the findings "provide important insights into the long-term durability of balloon-expandable transcatheter valves." The authors suggest that continuous monitoring of these patients beyond four-year follow-up is "essential to provide definite data on long-term transcatheter valve durability."

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