Author + information
- Received December 17, 2014
- Accepted January 1, 2015
- Published online April 27, 2015.
- Alison Duncan, MB BS, BSc, PhD∗,
- Peter Ludman, MA, MD†,
- Winston Banya, MSc∗,
- David Cunningham, MA‡,
- Damian Marlee, MA‡,
- Simon Davies, MA, MB BS∗,
- Michael Mullen, MD§,
- Jan Kovac, MD‖,
- Thomas Spyt, MD‖ and
- Neil Moat, MB, BS, MS∗∗ ()
- ∗Biomedical Research Unit, The Royal Brompton Hospital, London, United Kingdom
- †Queen Elizabeth Hospital, Birmingham, United Kingdom
- ‡National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom
- §University College London, Institute of Cardiovascular Science, London, United Kingdom
- ‖University Hospital Leicester, Leicester, United Kingdom
- ↵∗Reprint requests and correspondence:
Dr. Neil Moat, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom.
Objectives The U.K. Transcatheter Aortic Valve Implantation Registry reported 30-day and 1-year mortality rates of 7.1% and 21.4%, respectively, for patients who underwent transcatheter aortic valve replacement (TAVR) in the United Kingdom between 2007 and 2009. The study aim was to report long-term outcomes in this same cohort of patients.
Background There are few data on outcomes beyond 3 years after TAVR in any notable number of patients.
Methods Data from all TAVR procedures performed in the United Kingdom between January 2007 and December 2009 were prospectively collected. All-cause mortality status was reported in March 2014. Mortality tracking was achieved in 97.7% patients.
Results The minimal time from replacement to census was 4.1 years, and the maximal time was 7.0 years. The 3- and 5-year survival rates were 61.2% and 45.5%, respectively. Independent predictors of 3-year mortality were renal dysfunction (hazard ratio [HR]: 1.65), atrial fibrillation (HR: 1.36), logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥18.5 (HR: 1.33), respiratory dysfunction (HR: 1.28), and ventricular dysfunction (left ventricular ejection fraction <30%) (HR: 1.53). Coronary artery disease (HR: 1.28) and age (HR: 1.03) were additional independent predictors of mortality at 5 years. Stroke within 30 days of TAVR was the only independent procedural predictor of mortality at 3 and 5 years (HR: 2.17 at 3 years). Device type, access route, and paravalvular leak did not independently predict long-term outcome.
Conclusions In the large U.K. Transcatheter Aortic Valve Implantation Registry, long-term outcomes after TAVR are favorable with 3- and 5-year survival rates of 61.2% and 45.5%, respectively. Long-term survival after TAVR is largely determined by intrinsic patient factors. Other than stroke, procedural variables, including paravalvular aortic leak, did not appear to be independent predictors of long-term survival.
Dr. Kovac is a consultant to and proctor for Medtronic; and a proctor for Edwards Lifesciences. Dr. Moat is a consultant and proctor for Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 17, 2014.
- Accepted January 1, 2015.
- American College of Cardiology Foundation