Long-term outcomes after transcatheter aortic valve implantation : insights on prognostic factors and valve durability from the Canadian multicenter experience

Authors: Rodés-Cabau, Josep; Webb, John G. (John Graydon); Cheung, Anson; Ye, Jian; Dumont, Éric; Osten, Mark; Feindel, Christopher M.; Natarajan, Madhu K.; Velianou, James L.; Martucci, Giussepe; De Varennes, Benoît; Chisholm, Robert; Peterson, Mark; Thompson, Chris; Wood, David A.; Toggweiler, Stefan; Gurvitch, Ronen; Lichtenstein, Samuel V.; Doyle, DanielDeLarochellière, Robert; Teoh, Kevin; Chu, Victor; Bainey, Kevin; Lachapelle, Kevin; Cheema, Asim; Latter, David; Dumesnil, Jean G.Pibarot, Philippe; Horlick, Eric
Abstract: OBJECTIVES: This study sought to evaluate the long-term outcomes after transcatheter aortic valve implantation (TAVI) in the Multicenter Canadian Experience study, with special focus on the causes and predictors of late mortality and valve durability. BACKGROUND: Very few data exist on the long-term outcomes associated with TAVI. METHODS: This was a multicenter study including 339 patients considered to be nonoperable or at very high surgical risk (mean age: 81 ± 8 years; Society of Thoracic Surgeons score: 9.8 ± 6.4%) who underwent TAVI with a balloon-expandable Edwards valve (transfemoral: 48%, transapical: 52%). Follow-up was available in 99% of the patients, and serial echocardiographic exams were evaluated in a central echocardiography core laboratory. RESULTS: At a mean follow-up of 42 ± 15 months 188 patients (55.5%) had died. The causes of late death (152 patients) were noncardiac (59.2%), cardiac (23.0%), and unknown (17.8%). The predictors of late mortality were chronic obstructive pulmonary disease (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.53 to 3.11), chronic kidney disease (HR: 1.08 for each decrease of 10 ml/min in estimated glomerular filtration rate, 95% CI: 1.01 to 1.19), chronic atrial fibrillation (HR: 1.44, 95% CI: 1.02 to 2.03), and frailty (HR: 1.52, 95% CI: 1.07 to 2.17). A mild nonclinically significant decrease in valve area occurred at 2-year follow-up (p < 0.01), but no further reduction in valve area was observed up to 4-year follow-up. No changes in residual aortic regurgitation and no cases of structural valve failure were observed during the follow-up period. CONCLUSIONS: Approximately one-half of the patients who underwent TAVI because of a high or prohibitive surgical risk profile had died at a mean follow-up of 3.5 years. Late mortality was due to noncardiac comorbidities in more than one-half of patients. No clinically significant deterioration in valve function was observed throughout the follow-up period.
Document Type: Article de recherche
Issue Date: 6 November 2012
Open Access Date: Restricted access
Document version: VoR
Permalink: http://hdl.handle.net/20.500.11794/7710
This document was published in: Journal of the American College of Cardiology, Vol. 60 (19), 1864–1875 (2012)
https://doi.org/10.1016/j.jacc.2012.08.960
Elsevier Biomedical
Alternative version: 10.1016/j.jacc.2012.08.960
23062535
Collection:Articles publiés dans des revues avec comité de lecture

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