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.
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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