5-Year Outcome After Transcatheter Aortic Valve Implantation

Objectives The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI). Background Little is known about long-term outcomes following TAVI. Methods The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded. Results Mean aortic valve gradient decreased from 46 +/- 18 mm Hg to 10 +/- 4.5 mm Hg after TAVI and 11.8 +/- 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 +/- 0.17 cm(2) to 1.67 +/- 0.41 cm(2) after TAVI and 1.40 +/- 0.25 cm(2) at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction (moderate transvalvular regurgitation in 1, moderate stenosis in 1, and moderate mixed disease in 1). Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years (95% confidence interval [CI]: 2.6 to 4.3), and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (adjusted hazard ratio [HR]: 2.17; 95% CI: 1.28 to 3.70) and at least moderate paravalvular regurgitation (adjusted HR: 2.98; 95% CI: 1.44 to 6.17). Conclusions Our study demonstrated favorable long-term outcomes after TAVI. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, notably chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival. (J Am Coll Cardiol 2013;61:413-9) (C) 2013 by the American College of Cardiology Foundation