Three of Five TAVR Patients Alive at 3 Years: UK Registry Analysis

April 30, 2015

KANSAS CITY, MO — Three years after transcatheter aortic-valve replacement (TAVR), 61% of individuals with severe symptomatic aortic stenosis who receive the new valve remain alive, according to data from the UK Transcatheter Aortic Valve Implantation (TAVI) Registry[1].

At 5 years, 45.5% of the UK patients who underwent TAVR were still alive.

Survival to 3 years was largely predicated on patient characteristics, with baseline renal dysfunction, atrial fibrillation, respiratory disease, impaired left ventricular function, and a higher EuroSCORE (>18.5) associated with an increased risk of mortality, report investigators.

"The only procedural variable that was an independent predictor of long-term mortality was postprocedural stroke, which was associated with a more-than-twofold risk of death at 3 years [and] with a similar finding at 5 years," write Dr Alison Duncan (Royal Brompton Hospital, London, UK) and colleagues in their paper, published in the April 27, 2015 issue of JACC: Cardiovascular Interventions. "At 5 years, advancing age emerged as an additional independent predictor of mortality, as did coronary artery disease."

The data is based on 870 patients who underwent TAVR in the UK between 2007 and 2009. The mean age of patients at the time of implantation was 82 years, and the minimum time from TAVR to data census was 4.1 years (maximum 7.0 years). Patients in the registry received either the Sapien balloon-expandable valve (Edwards Lifesciences) or the self-expanding CoreValve (Medtronic).

Overall, investigators say the survival rate is comparable to data from other single-center studies and is also comparable with the 2-year survival rate in the Placement of Aortic Transcatheter Valves (PARTNER) cohort A trial. In PARTNER A, which included high-risk patients eligible for surgery, the 2-year survival rate was 66.1%.

The researchers add the UK registry survival rate is higher than the 3-year survival rate observed in the PARTNER cohort B trial. In that study, which included extreme-risk patients ineligible for valve-replacement surgery, the survival rate was 45.9% at 3 years. They point out, however, that the UK registry includes a mix of high- and extreme-risk patients (PARTNER A- and B-type patients).

Steep Decline From 30 Days to 1 Year, But Risk Resolves

In an editorial[2], Dr Peter Block (Emory University Hospital, Atlanta, GA) said the "most important take-home message from this UK TAVI registry is that the initial steep drop in survival seen in the first year after TAVI becomes less steep in ensuing years." In the UK registry, survival, which was previously reported by heartwire , was 92.9% at 30 days, 78.6% at 1 year, and 73.7% at 2 years.

Following the initial risks, mortality is reduced to approximately 6% to 8% per year as the patient recovers from the implantation, he adds.

"These data are similar to survival in elderly patients in their eighth and ninth decades who have undergone surgical aortic-valve replacement," writes Block. "TAVR, like surgery, relieves aortic stenosis and its associated death threat, and patients seem to join the survival curves historically seen in the general population from actuarial tables of populations older than 80 years."

Block added that while paravalvular leak and the need for a pacemaker did not influence mortality at 3 or 5 years, there remains a need to determine whether the "TAVR-induced" factors contribute to clinical events on longer-term follow-up.

Duncan reports no relevant financial relationships. Disclosures for the coauthors are listed in the article. Block holds equity in Direct Flow Medical.

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