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Long-Term Outcomes After Transcatheter Aortic Valve Implantation in High-Risk Patients With Severe Aortic Stenosis: The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry

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Objectives

The objective was to define the characteristics of a real-world patient population treated with transcatheter aortic valve implantation (TAVI), regardless of technology or access route, and to evaluate their clinical outcome over the mid to long term.

Background

Although a substantial body of data exists in relation to early clinical outcomes after TAVI, there are few data on outcomes beyond 1 year in any notable number of patients.

Methods

The U.K. TAVI (United Kingdom Transcatheter Aortic Valve Implantation) Registry was established to report outcomes of all TAVI procedures performed within the United Kingdom. Data were collected prospectively on 870 patients undergoing 877 TAVI procedures up until December 31, 2009. Mortality tracking was achieved in 100% of patients with mortality status reported as of December 2010.

Results

Survival at 30 days was 92.9%, and it was 78.6% and 73.7% at 1 year and 2 years, respectively. There was a marked attrition in survival between 30 days and 1 year. In a univariate model, survival was significantly adversely affected by renal dysfunction, the presence of coronary artery disease, and a nontransfemoral approach; whereas left ventricular function (ejection fraction <30%), the presence of moderate/severe aortic regurgitation, and chronic obstructive pulmonary disease remained the only independent predictors of mortality in the multivariate model.

Conclusions

Midterm to long-term survival after TAVI was encouraging in this high-risk patient population, although a substantial proportion of patients died within the first year.

Key Words

aortic stenosis
registry
transcatheter aortic valve implantation

Abbreviations and Acronyms

AR
aortic regurgitation
AVR
aortic valve replacement
CAD
coronary artery disease
CCAD
Central Cardiac Audit Database
COPD
chronic obstructive pulmonary disease
LV
left ventricular
NYHA
New York Heart Association
TAVI
transcatheter aortic valve implantation

Cited by (0)

Dr. Moat is a consultant to Medtronic; and has received honoraria from Edwards LifeSciences and Abbott. Dr. Young is a proctor for Edwards. Dr. Thomas is a consultant and proctor for Edwards. Dr. Kovac is a consultant to and proctor for Medtronic; and a proctor for Edwards Lifesciences. Dr. Spyt is a consultant for Edwards Lifesciences. Dr. MacCarthy is a proctor for Edwards Lifesciences. Dr. Wendler is a consultant and proctor for Edwards Lifesciences. Dr. Hildick-Smith is a proctor for Medtronic. Dr. Blackman is a proctor for Medtronic CoreValve. Dr. Levy is a proctor for Medtronic CoreValve. Dr. Brecker is a proctor for Medtronic CoreValve. Dr. Mullen has received consultancy and research grants from Medtronic; and consultancy, teaching grants, and research grants from Edwards LifeSciences.

All other authors have reported they have no relationships relevant to the contents of this paper to disclose.