UK Registry Finds Long-Term Survival After TAVR Depends on Patient Characteristics

PARIS, France—Nearly half of high-risk patients who undergo transcatheter aortic valve replacement (TAVR) for severe aortic stenosis live at least 5 years after the procedure, with long-term survival affected not by procedural and device factors but rather by patient characteristics. The findings, from the UK TAVI registry, were announced in a Hot Line session on May 22, 2014, at EuroPCR.

Alison Duncan, MD, of Royal Brompton Hospital (London, United Kingdom), presented 3- and 5-year outcomes of 870 high-risk patients with severe aortic stenosis enrolled in the registry, which captured all TAVR procedures performed in the United Kingdom from 2007 to 2009. Mortality data were gathered as recently as July 2013. Minimum follow-up duration was 3.5 years and maximum 6.4 years.

Survival rates were 61.6% at 3 years and 48.4% at 5 years. As reported in 2011 paper published in the Journal of the American College of Cardiology, 30-day and 1-year survival for the same dataset were 71.5% and 21.4%, respectively.

On multivariable analysis, several baseline characteristics predicted mortality at 3 years (table 1).

Table 1. Independent Predictors of Mortality at 3 Years After TAVR

 

HR

95% CI

P Value

A-Fib

1.35

1.05-1.72

.018

COPD

1.30

1.02-1.65

.034

Creatinine > 200 µg/mmol

1.69

1.15-2.48

.008

Euroscore ≥ 18.5

1.24

1.05-1.47

.012


At 5 years, many of the same factors were predictive, with the addition of patient age and diabetes (table 2).

Table 2. Independent Predictors of Mortality at 5 Years After TAVR

 

HR

95% CI

P Value

A-Fib

1.34

1.08-1.68

.009

COPD

1.29

1.04-1.61

.022

Creatinine > 200 µg/mmol

1.79

1.25-2.56

.002

Euroscore ≥ 18.5

1.28

1.03-1.59

.026

Age

1.03

1.01-1.05

.001

Diabetes

1.15

1.03-1.28

.01


Neither valve type nor access route independently predicted long-term mortality. Neither did known predictors of short-term mortality including aortic regurgitation and need for permanent pacemaker, Dr. Duncan added.

According to Dr. Duncan, “Survival after TAVI appears to be biphasic, with a very high early hazard phase at the 30 day to 1 year time period, but…almost 50% of patients were still alive 5 years afterward [even in this] very early cohort of patients, a very high-risk TAVI group. Also, their survival is similar to octogenarian patients undergoing conventional aortic valve surgery.”

Session co-chair Axel Linke, MD, of the University of Leipzig Heart Center (Leipzig, Germany), asked why the procedural complications affecting mortality no longer hold importance. These complications remain important, Dr. Duncan stressed, “but [vulnerable] patients have all been siphoned out early on, because their mortality is obviously at a much earlier stage. What we are left with is what the patient is actually made up of, their intrinsic factors.”

COPD is consistently emerging as a prognostic indicator, pointed out Bernard Prendergast, MD, of John Radcliffe Hospital (Oxford, United Kingdom), referring to 5-year follow-up from another research group (Toggweiler S. J Am Coll Cardiol. 2013;61:413-419). “Do you think we should now be saying that significant COPD is a relative contraindication to TAVI when we’re selecting patients?” he asked.

“Certainly, it’s probably looking like it’s heading that way,” Dr. Duncan agreed.

 


Source:

Duncan A. 3- and 5-year outcomes after TAVI in high-risk patients with severe aortic stenosis: the UK TAVI registry. Presented at: EuroPCR; May 22, 2014; Paris, France.

 

 

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Disclosures
  • Dr. Duncan reports no relevant conflicts of interest.

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