Loss in life expectancy in patients with aortic stenosis undergoing transcatheter aortic valve replacement

Background Aortic valve replacement (AVR) improves morbidity and mortality in patients with severe aortic stenosis with transcatheter aortic valve replacement (TAVR) being the most common mode of intervention. Life expectancy after TAVR relative to the general population provides an absolute, population-referenced measure integrating population-specific mortality with long-term effectiveness. Purpose The present study aims to quantify the loss in life expectancy after successful transfemoral TAVR compared with the age-, sex-, and calendar year-matched general population in Switzerland. Methods The study population consists of consecutive patients with native severe aortic stenosis who underwent successful transfemoral TAVR between February 2011 and December 2023 enrolled in the nationwide, prospective SwissTAVI registry. Loss in life expectancy was defined as the difference between the expected and observed restricted mean survival time truncated at 5, 8, and 10 years of follow-up. Expected survival for each patient was derived from age-, sex-, and calendar year-matched Swiss general population data obtained from the Human Mortality Database. Results In the analysis of 13,651 patients (median age 82 years; 46.2% female; median Society of Thoracic Surgeons Predicted Risk of Mortality [STS-PROM] score 3.3%), 5,096 deaths occurred during 39,266 patient-years of observation (truncated at 10 years). The mean loss in life expectancy after successful transfemoral TAVR was 0.37 years (95% CI 0.34 to 0.39), 1.05 years (95% CI 1.01 to 1.09), and 1.58 years (95% CI 1.51 to 1.64) at 5, 8, and 10 years, respectively. The loss was largest in younger patients (<70 years: 3.86 years [95% CI 3.55 to 4.16]) and smallest in the very elderly (≥90 years: -0.09 years [95% CI -0.25 to 0.05]). High surgical risk was associated with larger loss in life expectancy (STS-PROM <4%: 1.28 years [95% CI 1.18 to 1.35]; STS-PROM >8%: 2.21 years [95% CI 2.04 to 2.39], respectively). Cardiovascular and non-cardiovascular comorbidities, as well as markers of extra-valvular cardiac damage, were associated with a more pronounced reduction in life expectancy. Conclusion Life expectancy after successful transfemoral TAVR did not normalize relative to the reference population, with the largest loss in life expectancy observed among younger and high-surgical risk aortic stenosis patients.