Long term outcomes of patients treated with Transcatheter Aortic Valve Implantation: A large single-centre prospective registry
2Department of Cardio-thoracic Surgery, Rabin Medical Center, Israel
Introduction: With expanded indications, better operator experience and improved devices, transcatheter aortic valve implantation (TAVI) is a well-established therapeutic intervention for aortic stenosis (AS) patients at prohibitive, high, intermediate and low surgical risk. Herein, we report our long-term experience treating severe AS patients with TAVI.
Material and Methods: Our data was taken from a prospective registry of consecutive patients undergoing TAVI for symptomatic AS at our institution. Data was analysed from May 2008- February 2018.
Results: Our cohort included 836 patients (mean follow up of 1281.3±792.7 days). The mean age was 81.4±6.7 years, 52.5% female. The mean Society of Thoracic Surgeon (STS) Score was 5.75±4.1. The mean echocardiographic mean gradient at baseline was 44±14.9mmHg. TAVI was performed via the transfemoral, trans-apical and subclavian route in 91.3%, 5.1% and 3.6% of patients respectively. A self-expandable device was used in 68.2% of cases, balloon expandable in 28% and 3.8% of patients were treated with other transcatheter heart valves. A vascular complication was seen in 2.6% of cases. In-hospital complications included 2.9% with cerebrovascular events (CVA) , acute kidney injury in 6.7% with a 14.4% pacemaker insertion rate. In hospital mortality was 2.6% . The mean hospital stay 4.3±3.5 days .
At one year follow up, the mean NYHA status was decreased to 1.2+-2.8 and 9.7% of patients (47/484) had been re-hospitalized. While at baseline 76.7% of the cohort were in NYHA class III/IV, at 4 years this had decreased to 2% of the cohort.
5 year follow up data was obtained for 249 patients, 65.4% had died of which 14.7% had had a cardiac related death. The mean echocardiographic mean gradient at 5 years follow up was 8.6mmHg +-6.3
Conclusion
TAVI patients have a favourable long-term outcome, with excellent valve hemodynamic parameters and good clinical outcomes.
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