Key result
Transapical TAVI resulted in an overall survival of 41% at 5 years, with cardiogenic shock (HR 2.80) and NYHA class IV (HR 1.69) emerging as strong predictors of follow-up mortality.
Why the study?
What are the long-term survival rates and predictors of mortality up to 5 years in patients undergoing transapical TAVI?
Cohort (n=730)
What are the long-term survival rates and predictors of mortality up to 5 years in patients undergoing transapical TAVI?
Transapical TAVI provides acceptable long-term survival up to 5 years, with mortality primarily driven by non-cardiac comorbidities, advanced heart failure, and procedure-related complications.
5-year transapical TAVI survival data in a large cohort leave open questions on durability and generalizability to contemporary practice.
OBJECTIVES: A major limitation of transcatheter aortic valve implantation (TAVI) is that its long-term outcomes are still unknown. The purpose of this study was to evaluate survival up to 5 years after implantation and to identify predictors of follow-up mortality in a large cohort of patients who underwent exclusively a transapical TAVI procedure. METHODS: Outcomes in terms of mortality and freedom from structural valve deterioration were evaluated in 730 consecutive patients. The median age was 80 years (range, 29-99 years). Forty patients (5.5%) presented with cardiogenic shock. The mean logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 35.0 ± 21.9%, the mean EuroSCORE II was 16.2 ± 16.2% and the mean Society of Thoracic Surgeons predicted operative mortality score was 14.0 ± 11.8%. According to allocation in EuroSCORE II quartiles, four equal subgroups of different risk profile were defined with low, intermediate, high and very high arithmetic risks. RESULTS: The overall 30-day mortality rate was 4.5% (33/730); 3.9% (27/690) in patients without cardiogenic shock. Survival at 1, 3 and 5 years were 80 ± 2%, 60 ± 2% and 41 ± 4%. Best survival up to 58 ± 7% at 5 years was found in the low and intermediate arithmetic risk quartile (P ≤ 0.001). In multivariable analysis, age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.03-1.06, P < 0.001), New York Heart Association class IV (HR: 1.69, CI: 1.28-2.23, P < 0.001), cardiogenic shock (HR: 2.80, CI: 1.73-4.54, P < 0.001), serum creatinine level (HR: 1.24, CI: 1.10-1.40, P < 0.001) and atrial fibrillation (HR: 1.66, CI: 1.27-2.16, P < 0.001) were predictive of follow-up mortality, whereas the absence of post-procedural acute kidney injury (HR: 0.50, CI: 0.38-0.67, P < 0.001) was protective against follow-up mortality. The freedom from structural valve deterioration requiring reoperation on the prosthesis was 95.7 ± 1.9% at 5 years. CONCLUSIONS: We identified three main causes of follow-up mortality: non-cardiac comorbidity, advanced stages of heart failure and procedure-related complications. Further improvements of the TAVI technique should concentrate on the complete exclusion of the latter.
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Unbehaun et al. (2014) conducted a cohort in Aortic valve disease requiring TAVI (n=730). Transapical transcatheter aortic valve implantation (TAVI) was evaluated on Survival at 5 years. Transapical TAVI resulted in an overall survival of 41% at 5 years, with cardiogenic shock (HR 2.80) and NYHA class IV (HR 1.69) emerging as strong predictors of follow-up mortality.
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