Long-Term Outcomes of High-Risk or Inoperable Patients Who Underwent Transcatheter Aortic Valve Implantation

Abstract

Few studies have evaluated transcatheter aortic valve implantation (TAVI) beyond 5 years. We investigated long-term outcomes (≥5 years) and transcatheter heart valve (THV) performance in patients who had undergone TAVI at least 5 years previously, based on annual follow-up. We reviewed 114 consecutive patients who were of high surgical risk or inoperable and underwent TAVI for severe aortic stenosis from October 2009 to November 2013. There was no lost to follow-up, and median time to death or latest follow-up was 5.0 years (range: 0.1 to 8.5). Structural valve degeneration (SVD) was defined on transthoracic echocardiography (TTE) as follows: (1) mean pressure gradient ≥20 mm Hg with a >10 mm Hg increase from the post-TAVI baseline, and/or (2) moderate or severe transvalvular regurgitation. The mean patient age was 82.7 ± 6.4 years, and 37.7% of patients were men. Median Society of Thoracic Surgeons score was 7.6% (interquartile range 5.8 to 10.9). TTE ≥5 years was 76.1% complete (51 of 67 patients who survived ≥5 years postoperatively). The estimated cumulative survival rates at 1, 3, 5, and 7 years were 88.6%, 72.8%, 58.8%, and 45.3%, respectively. Albumin <3.5 g/dl was strongly associated with increased long-term mortality on multivariate analysis. Longitudinal TTE confirmed durable performance of THV up to 7 years in the majority of patients; however, 6 patients (5.3% of the total cohort) experienced SVD during the follow-up. In conclusion, this study demonstrated favorable long-term survival and stable THV performance after TAVI, although SVD was not rare.