Long-Term Outcomes of 717 Consecutive Patients Treated with Transcatheter Aortic Valve Implantation and Propensity Score Matched-Analysis of Early Versus New Generation Valves

Background: Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective treatment for severe aortic stenosis (AS) in patients with high or prohibitive surgical risk, and has been rapidly expanding to include lower risk and younger patients. We herein present our institution 9-year experience of TAVI.

Methods: Analysis of 717 consecutive patients undergoing TAVI at our institution between November 2008 and November 2017 with a median follow up of 1044 days was carried out. Patients were distinguished by access and treated patient tertiles to evaluate temporal changes in TAVI and long-term outcomes. Propensity-score (PS) matched analysis was preformed to compare the impact of the early and new generation valve systems.

Results: With time, patient selection shifted towards lower risk (mean STS score 8.1 vs. 4 in the first and last patient tertile, respectively), and use of conscious sedation and trans-femoral access increased (p mild decreased from 13% to 3.7%, p=0.005. The composite of death and stroke declined in the short term (from 7.5% in the 1^st tertial to 3.3% in the last, p=NS), as well as in the long-term [Figure]. Independent predictors of 1 year death included periprocedural aspects (vascular complications, stroke and PVL) while death occurring later than 1 year was solely related to untied comorbid conditions (COPD, CKD stage IV/V, Frailty). Transvalvular gradients and residual regurgitation remained favorable up to 5 years follow-up. New generation valves showed a favorable PVL profile compared to PS matched early generation valves (p=0.001).

Conclusions: TAVI utilization is expanding to lower risk patients with greater predominance of the transfemoral route. With the adoption of newer, less invasive technologies, and the treatment of lower risk patients, procedural outcomes and long term clinical outcomes are improving dramatically.

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