Long-Term Outcomes After Transcatheter Aortic Valve Implantation Journal Articles uri icon

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  • OBJECTIVES: This study sought to evaluate the long-term outcomes after transcatheter aortic valve implantation (TAVI) in the Multicenter Canadian Experience study, with special focus on the causes and predictors of late mortality and valve durability. BACKGROUND: Very few data exist on the long-term outcomes associated with TAVI. METHODS: This was a multicenter study including 339 patients considered to be nonoperable or at very high surgical risk (mean age: 81 ± 8 years; Society of Thoracic Surgeons score: 9.8 ± 6.4%) who underwent TAVI with a balloon-expandable Edwards valve (transfemoral: 48%, transapical: 52%). Follow-up was available in 99% of the patients, and serial echocardiographic exams were evaluated in a central echocardiography core laboratory. RESULTS: At a mean follow-up of 42 ± 15 months 188 patients (55.5%) had died. The causes of late death (152 patients) were noncardiac (59.2%), cardiac (23.0%), and unknown (17.8%). The predictors of late mortality were chronic obstructive pulmonary disease (hazard ratio [HR]: 2.18, 95% confidence interval [CI]: 1.53 to 3.11), chronic kidney disease (HR: 1.08 for each decrease of 10 ml/min in estimated glomerular filtration rate, 95% CI: 1.01 to 1.19), chronic atrial fibrillation (HR: 1.44, 95% CI: 1.02 to 2.03), and frailty (HR: 1.52, 95% CI: 1.07 to 2.17). A mild nonclinically significant decrease in valve area occurred at 2-year follow-up (p < 0.01), but no further reduction in valve area was observed up to 4-year follow-up. No changes in residual aortic regurgitation and no cases of structural valve failure were observed during the follow-up period. CONCLUSIONS: Approximately one-half of the patients who underwent TAVI because of a high or prohibitive surgical risk profile had died at a mean follow-up of 3.5 years. Late mortality was due to noncardiac comorbidities in more than one-half of patients. No clinically significant deterioration in valve function was observed throughout the follow-up period.


  • Rodés-Cabau, Josep
  • Webb, John G
  • Cheung, Anson
  • Ye, Jian
  • Dumont, Eric
  • Osten, Mark
  • Feindel, Christopher M
  • Natarajan, Madhu
  • Velianou, James
  • Martucci, Giussepe
  • DeVarennes, Benoît
  • Chisholm, Robert
  • Peterson, Mark
  • Thompson, Christopher R
  • Wood, David
  • Toggweiler, Stefan
  • Gurvitch, Ronen
  • Lichtenstein, Samuel V
  • Doyle, Daniel
  • DeLarochellière, Robert
  • Teoh, Kevin
  • Chu, Victor
  • Bainey, Kevin
  • Lachapelle, Kevin
  • Cheema, Asim
  • Latter, David
  • Dumesnil, Jean G
  • Pibarot, Philippe
  • Horlick, Eric

publication date

  • November 2012

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