Long-term survival outcome after transcatheter aortic valve implantation.

Abstract

Background: Transcatheter Aortic Valve Implantation (TAVI) is an alternative for patients with symptomatic aortic stenosis who are considered to have high surgical risk. The objective of the study was to investigate the clinical outcomes and survival rates following TAVI. Method: We analysed 172 patients who underwent TAVI from August 2010 to August 2015. Patients were followed-up for one month, six months and then annually post-TAVI. The data was based on their echocardiographic report and evaluation from a Cardiologist. Data set was complete for >95% of the cohort. Statistical analysis was performed with MedCalc and GraphPad software. Results: The average age of the cohort was 84.5±4.7 years at the time of procedure. 77% of patients had a New York Association (NYHA) score of III/IV pre-TAVI with significant improvement to only 2% immediately (P<0.0001, RR 0.23) and 6% after three years (P<0.0001, RR 0.24) post TAVI. The mean Society of Thoracic Surgeons ' (STS) score was 5.2±3.2. The mortality and cerebrovascular accident rates within the first thirty days were 1% respectively. Mean inpatient stay was 6.6±4.4 days with 7% admitted into intensive care. 5% had a second valve implanted during the same procedure due to severe aortic regurgitation or malposition while 3% required reintervention (second procedure or transition to surgery). Survival rates at one of five years were 89%, 77%, 63%, 45% and 28%, respectively. Median survival post - TAVI was 3.7 years based on the Kaplan-Meier curve. All deaths were classified as cardiac (32%), non-cardiac (55%) and unknown (13%) causes. Conclusion: TAVI patients had a low thirty days mortality risk as compared to their STS score predictions. Their NYHA scores also demonstrated significant improvements in their quality of life after the procedure. Survival in this elderly, high-risk population was reasonable and transitioning to younger patients will likely improve the survival outcome.