Author + information
- Received August 19, 2012
- Revision received November 1, 2012
- Accepted November 6, 2012
- Published online January 29, 2013.
- Stefan Toggweiler, MD,
- Karin H. Humphries, DSc,
- May Lee, MSc,
- Ronald K. Binder, MD,
- Robert R. Moss, MD,
- Melanie Freeman, MBBS,
- Jian Ye, MD,
- Anson Cheung, MD,
- David A. Wood, MD and
- John G. Webb, MD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. John G. Webb, St. Paul's Hospital, 1081 Burrard Street, Vancouver, British Columbia, Canada V6Z 1Y6
Objectives The purpose of this study was to investigate the 5-year outcome following transcatheter aortic valve implantation (TAVI).
Background Little is known about long-term outcomes following TAVI.
Methods The 5-year outcomes following successful TAVI with a balloon-expandable valve were evaluated in 88 patients. Patients who died within 30 days after TAVI were excluded.
Results Mean aortic valve gradient decreased from 46 ± 18 mm Hg to 10 ± 4.5 mm Hg after TAVI and 11.8 ± 5.7 mm Hg at 5 years (p for post-TAVI trend = 0.06). Mean aortic valve area increased from 0.62 ± 0.17 cm2 to 1.67 ± 0.41 cm2 after TAVI and 1.40 ± 0.25 cm2 at 5 years (p for post-TAVI trend <0.01). At 5 years, 3 patients (3.4%) had moderate prosthetic valve dysfunction (moderate transvalvular regurgitation in 1, moderate stenosis in 1, and moderate mixed disease in 1). Survival rates at 1 to 5 years were 83%, 74%, 53%, 42%, and 35%, respectively. Median survival time after TAVI was 3.4 years (95% confidence interval [CI]: 2.6 to 4.3), and the risk of death was significantly increased in patients with chronic obstructive pulmonary disease (adjusted hazard ratio [HR]: 2.17; 95% CI: 1.28 to 3.70) and at least moderate paravalvular regurgitation (adjusted HR: 2.98; 95% CI: 1.44 to 6.17).
Conclusions Our study demonstrated favorable long-term outcomes after TAVI. Signs of moderate prosthetic valve failure were observed in 3.4% of patients. No patients developed severe prosthetic regurgitation or stenosis. Comorbidities, notably chronic lung disease and at least moderate paravalvular regurgitation, were associated with reduced long-term survival.
- aortic stenosis
- aortic valve
- long-term outcome
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Drs. Toggweiler and Binder are supported by a grant from the Swiss National Foundation. Drs. Binder, Cheung, Moss, Rodés-Cabau, Webb, Wood, and Ye are consultants to Edwards Lifesciences.
All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 19, 2012.
- Revision received November 1, 2012.
- Accepted November 6, 2012.
- 2013 American College of Cardiology Foundation