Key result
Portico TAVI shows a ~38% major adverse event rate at 3 years in severe AS.
Why the study?
There is uncertainty on the long-term effectiveness of transcatheter aortic valve implantation with the Portico valve in elderly patients with severe aortic valve stenosis.
Cohort (n=803)
Yes
TAVI with the Portico self-expanding valve demonstrates favorable long-term clinical and hemodynamic outcomes at a median of 3 years in elderly patients with severe aortic stenosis.
Answers are grounded in this paper and cite their sources.
High event rates with Portico TAVI warrant caution in elderly patients; leaves open need for comparative long-term data versus other valves.
AIM: Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. METHODS: We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. RESULTS: A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1-40.9%), with all-cause death in 35.1% (31.8-38.4%), stroke in 3.4% (1.3-3.4%), myocardial infarction in 1.0% (0.3-1.5%), and reintervention for valve degeneration in 1.1% (0.6-2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7-12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). CONCLUSIONS: Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.
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Giordano et al. (2023) conducted a cohort in Severe aortic valve stenosis (n=803). Transcatheter aortic valve implantation (TAVI) with the Portico valve was evaluated on Major adverse events (composite of all-cause death, stroke, myocardial infarction, and reintervention for valve degeneration) (95% CI 34.1-40.9). Transcatheter aortic valve implantation with the Portico valve in elderly patients with severe aortic stenosis resulted in a 37.5% rate of major adverse events and a 35.1% rate of all-cause death at a median follow-up of 3 years.
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