Long-term survival and ourtomes a large cohort of patients underwent with Transcatheter Aortic Valve Replacement: an 10-year single center TAVR experience

Abstract

Abstract The use of transcatheter aortic valve replacement (TAVR) has expanded as an alternative to surgical aortic valve replacement and has become a widely accepted treatment option for patients with severe aortic stenosis who are considered intermediate- and high-risk surgical candidates. The information concerning the long-term durability of TAV devices is currently limited. The interplay between estimated life expectancy and prosthetic heart valve durability is a key consideration in these discussions. The aim of this study was to determine the clinical outcomes, survival and the factors predicting mortality after TAVR Methods From April 2008 to December 2020, the auto-expandible and baloom-expandable prostheses were implanted in 991 patients with symptomatic severe aortic stenosis with intermediate, high and deemed risk. Results The mean age was 79.43±6.7 years. The logistic EuroSCORE II and STS score were 5.92±5% and 5.22±3.7%, respectively. The implantation success rate was 98.7%. In-hospital mortality was 3.3%, and the combined endpoint of death, vascular complications, myocardial infarction or stroke had a rate of 17.2%. The late mortality (beyond 30 days) was 43.2%. Survival at 1, 3, 5, 7, 9 and ten years were 88.2%, 68.2%, 50,1%, 38.1%, 26.3% and 16.4% respectively, after a mean follow-up of 44.8±31 months. The NYHA functional class improved from 3.3±0.7 to 1.76±0.5 in the follow-up. At 7 years, 9 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitationI. In 7 patients were treated again with TAVR. The predictors of cumulative mortality were: Charlson index [HR 1.167 (95% CI 1.078–1.264), p=0.001], Readmision Heart Failure [HR 2.793 (95% CI 1.948–4.005), p=0.001], stroke post-TAVR [HR 2.919 (95% CI 1.965–4.336), p=0.001], Left ventricular ejection fraction [HR −1.012 (95% CI 1.002–1.022) p=0.021] and Karnosfky index [HR −0.984 (95% CI 0.975–0.993), p=0,001] but the requirement of pacemaker or residual aortic regurgitation after TAVR were not predictors [HR 0,979 (CI 95% 0.678–1.415), p 0.911] and [HR 1.087 (CI 95% 0.913–1.294), p=0.349]. Conclusions TAVR is associated with excellent clinical results at follow-up. Long-term survival depends particularly on comorbidities and the left ventricular ejection fraction Funding Acknowledgement Type of funding sources: None.