October 19th, 2011

U.K. Registry Tracks Long-Term TAVI Outcomes

The excitement over transcatheter aortic valve implantation (TAVI) has been tempered by the absence of long-term outcomes data and concerns that the procedure may not live up to its initial promise in real-world settings. Now a report from the U.K. TAVI Registry, which keeps track of every TAVI procedure performed in the U.K., sheds new light on the long-term outcomes of TAVI in real-world settings.

In a paper published in the Journal of the American College of Cardiology, Neil Moat and colleagues report the results of 877 TAVI procedures performed through 2009 in 870 high-risk patients at 25 centers (with a median of 24 implants per center). Mortality was ascertained in all patients:

  • 30-day survival: 92.9%
  • 1-year survival: 78.6%
  • 2-year survival: 73.7%

Mortality was higher in patients who received a nontransfemoral implant. Independent predictors of mortality were LVEF <30, the presence of moderate or severe aortic regurgitation, and COPD. At 30 days, the rate of stroke was 4.1% and the rate of MI was 1.3%.

The authors conclude that “although 30-day mortality was acceptable, there was a significant attrition between 30 days and 12 months, predominantly in the highest risk cohort.” The results support a randomized trial comparing TAVI to surgery in a less high-risk group of patients, they say.

In an accompanying editorial, Alec Vahanian, Dominique Himbert, and Bernard Iung write that the registry supports the use of TAVI in “high-risk or inoperable patients, when performed in properly trained centers.” Future efforts, they add, “should aim at improving patient selection both by a dedicated medicosurgical team and by improving procedural performance through careful training and improvement in technology.”

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