Key result
In a Brazilian registry of 418 patients undergoing TAVI, all-cause mortality was 9.1% at 30 days and 21.5% at 1 year, with TEE monitoring acting as a protective factor against overall mortality (HR 0.57).
Observational (n=418)
Yes
In a real-world Brazilian registry, TAVI demonstrated acceptable 1-year mortality, with comorbidities and procedural complications strongly predicting adverse outcomes, while intraprocedural TEE monitoring was protective.
TEE monitoring was associated with lower TAVI mortality; hypothesis-generating and requires randomized confirmation before practice change.
OBJECTIVE: The study sought to evaluate outcomes and predictors of mortality after transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI registries can reliably address outcomes and issues that adversely affect results in real-life. METHODS: All endpoints and complications were analyzed according to Valve Academic Research Consortium-2 criteria. RESULTS: Between January 2008 and January 2013, 418 patients underwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoral approach was used in 96.2% of the procedures. The CoreValve and Sapien XT prosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortality at 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease (COPD) (HR: 3.50), acute kidney injury (AKI) (HR: 3.07), stroke (HR: 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR: 2.76) emerged as independent predictors of overall mortality. COPD (OR: 3.00), major vascular complications (OR: 7.99) and device malpositioning (OR: 6.97) were predictors of early (≤30 days) mortality, while COPD (HR: 2.68), NYHA class III/IV (HR: 3.04), stroke (HR: 4.15), AKI (HR: 2.44) and moderate/severe PVR (HR: 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram (TEE) to monitor the procedure was found to be a protective factor against overall (HR: 0.57) and late (HR: 0.47) mortality. CONCLUSION: This multicenter registry reflected a real-life national TAVI experience. Comorbidities, periprocedural complications and moderate/severe PVR were associated with increased mortality and the use of TEE to monitor the procedure acted as a protective factor.
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Brito et al. (2014) conducted an observational in Patients undergoing transcatheter aortic valve implantation (n=418). Transcatheter aortic valve implantation (TAVI) was evaluated on All-cause mortality at 1 year. In a Brazilian registry of 418 patients undergoing TAVI, all-cause mortality was 9.1% at 30 days and 21.5% at 1 year, with TEE monitoring acting as a protective factor against overall mortality (HR 0.57).
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