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Original research article
Five-year follow-up after transcatheter aortic valve implantation for symptomatic aortic stenosis
  1. Ralf Zahn1,
  2. Nicolas Werner2,
  3. Ulrich Gerckens3,
  4. Axel Linke4,
  5. Horst Sievert5,
  6. Philipp Kahlert6,
  7. Rainer Hambrecht7,
  8. Stefan Sack8,
  9. Mohamed Abdel-Wahab9,
  10. Ellen Hoffmann10,
  11. Uwe Zeymer1,
  12. Steffen Schneider11
  13. The German Transcatheter Aortic Valve Interventions—Registry investigators
  1. 1Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
  2. 2Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
  3. 3none, none, Bonn, Germany
  4. 4Klinik für Kardiologie, Herzzentrum Leipzig, Leipzig, Germany
  5. 5Klinik für Kardiologie, CardioVasculäres Centrum Frankfurt, Katharinenkrankenhaus, Frankfurt, Germany
  6. 6Klinik für Kardiologie, Westdeutsches Herz- und Gefäßzentrum Essen, Universitätsklinikum Essen, Essen, Germany
  7. 7Klinik für Kardiologie, Herzzentrum Bremen, Bremen, Germany
  8. 8Abteilung für Kardiologie, Klinikum München Schwabing, Munich, Germany
  9. 9Abteilung für Kardiologie, Segeberger Kliniken, Bad Segeberg, Germany
  10. 10Abteilung für Kardiologie, Städtisches Klinikum München-Bogenhausen, Munich, Germany
  11. 11none, Stiftung Institut für Herzinfarktforschung, Luwigshafen, Germany
  1. Correspondence to Ralf Zahn, Chefarzt der Med. Klinik B, Kardiologie/ Pneumologie/ Angiologie/ Internistische Intensivmedizin, Herzzentrum Ludwigshafen, Bremserstraße 79, D - 67063 Ludwigshafen, Germany.; erzahn{at}aol.com

Abstract

Objectives Transcatheter aortic valve implantation (TAVI) has been implemented into the care of elderly patients suffering from severe symptomatic aortic stenosis. However, data on long-term follow-up are sparse and predictors of long-term mortality need to be evaluated to better select patients. Therefore, we aimed to analyse predictors of 5-year mortality after TAVI.

Methods We analysed data from the German Transcatheter Aortic Valve Interventions—Registry. Each of the 27 participating hospitals agreed to include all consecutive TAVI patients at their institution. Out of 1444 patients treated with TAVI, 1378 patients had a follow-up of at least 4.5 years (completeness 95.4%). Endpoint for this analysis was 5-year survival. Cox regression analysis was used to determine risk factors associated with this endpoint.

Results Patients who died were compared with survivors. The two groups showed multiple differences in patient characteristics, indications for interventions, preinterventional, as well as interventional characteristics and postinterventional events. Calculated 1-year mortality was 21.8% and 5-year mortality 59.1%. A higher logistic EuroScore was associated with a lower 5-year survival, being 45.5% in patients with a logistic EuroScore of <20%, 34.5% in those with 20% to 40% and 28.4% in patients with a logistic EuroScore >40%. Cox proportional hazard analysis revealed the following independent predictors of 5-year mortality: female gender (HR (HR)=0.66, 95% CI 0.56 to 0.77, p<0.0001), renal failure (HR=1.43, 95% CI 1.22 to 1.69, p<0.0001), prior mitral regurgitation ≥II° (HR=1.42, 95% CI 1.21 to 1.65, p<0.0001), residual aortic regurgitation ≥II° (HR=1.52, 95% CI 1.24 to 1.85, p<0.0001), atrial fibrillation (HR=1.38, 95% CI 1.18 to 1.64, p=0.0001), low gradient aortic stenosis (HR=1.48, 95% CI 1.19 to 1.84, p=0.0004), prior decompensation (HR=1.32, 95% CI 1.13 to 1.54, p=0.0006), frailty (HR=1.31, 95% CI 1.09 to 1.58, p=0.004), surgical TAVI (HR=1.42, 95% CI 1.12 to 1.80, p=0.004), age (by year) (HR=1.02, 95% CI 1.01 to 1.03, p=0.006), prior myocardial infarction (HR=1.29, 95% CI 1.07 to 1.57, p=0.009), urgent TAVI (HR=1.25, 95% CI 1.04 to 51, p=0.020) and diabetes mellitus (HR=1.20, 95% CI 1.02 to 1.40, p=0.024).

Conclusions These data from the early TAVI experience show a 5-year mortality of 59.1%. Some of the predictors of 5-year mortality seem to be modifiable, such as residual aortic regurgitation, type of TAVI access route and concomitant mitral regurgitation.

  • endovascular procedures for aortic and vascular disease
  • transcatheter valve interventions

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Footnotes

  • Contributors RZ and NW contributed equally to this work.

  • Funding This study was partially funded by an unrestricted grant from the Deutsche Herzstiftung as well as by an unrestricted grant from the StiftungInstitut für Herzinfarktforschung (IHF) Ludwigshafen.

  • Competing interests AL, HS, PK, MA-W, SS worked as proctors for either Medtronic or Edwards or both and received speakers’ honoraria. UG worked as proctor and consultant and received speakers’ honoraria from Medtronic Inc. and Boston Scientific Inc. HS is member of the scientific advisory board of JenaValve technology. RZ and EH have received research funding from Medtronic and Edwards Lifesciences.

  • Patient consent Obtained.

  • Ethics approval Ethik Kommission Rheinland-Pfalz, Mainz.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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