Transcatheter Aortic Valve Implantation: Clinical Results and Long-term Outcome

Background: Transcatheter aortic valve implantation (TAVI) is the contemporary treatment of choice for high/prohibitive surgical risk patients with severe symptomatic aortic stenosis.

Methods: Outcomes of 480 (57% female) severe symptomatic aortic stenosis patients treated with TAVI and followed up to 6.5 years (mean 756 days), were analyzed and reported according to the Valve Academic Research Consortium 2 definitions. The primary end point was death from any cause.

Results TAVI patient were characterized by advanced age (mean: 82±6.9 years), high mean logistic EuroScore II (6.0±4.9) and STS (7.2±4.7) scores. The Medtronic-CoreValve, the Edwards-Sapien, the Corevalve Evolut R, the Lotus Valve System and the Edwards-Sapien3 devices were utilized in 283 (58%), 113 (24%), 52 (11%), 18 (4%) and 14 (3%) of patients; respectively. The trans-femoral, trans-axillar, trans-apical, trans-aortic and retroperitoneal route were used in 410, 47, 21, 1 and 1 of the cases; respectively. Procedural success was 94%. A second valve was needed in 22 (4.6%) patients. One month, 1 year, 3 years and 5 years survival rates were 96.7%, 90.5%, 71.8%, and 57.8%; respectively. Any vascular complications occurred in 86 (18%) patients, mostly treated ad-hoc using catheter-based techniques. Peri-procedural\in-hospital stroke was diagnosed in 16 (3.3%) patients. Permanent pacemaker implantation was required in 67 (14%) patients: 54 (19%) in CoreValve and 7 (5.3%) in Sapien valves. Paravalvular leak (≥moderate) was noted in 41 (17%) patients. After the procedure, mean aortic valve gradients decreased from 48.2±18 to 8±8 mmHg (p<0.001). The median length of hospital stay was 4 (3-5) days. Symptomatic improvement was evident and consistent during follow up, having 88% of patients in NYHA-FC I or II.

Conclusions: Transcatheter aortic valve implantation is associated with excellent outcomes in mostly elderly patients with severe symptomatic aortic stenosis. This report also demonstrates the long durability of the procedure and implanted devices.