Original title: 5-Year Outcome After Aortic Valve Implantation Reference: Stefan Toggweiler, et al. J Am Coll Cardiol 2013;61:413–9
Percutaneous aortic valve implantation (TAVI) is now a valid strategy as we know its short and medium term evolution but we do not have enough information available about the long term.
The aim of this study was to analyze the clinical and hemodynamic evolution after five years. Between January 2005 and March 2007, 111 patients received the balloon-expandable Cribier-Edwards SAPIEN valve (Edwards Lifesciences, Irvine, California). This cohort represents the first human experience with the valve in non-operable patients, yet so many steps in the procedure were not standardized and periprocedural mortality rate was relatively high. Failed implant patients, or those who died within 30 days, were excluded, leaving 88 patients for long term analysis.
Access was trans-femoral in 73% and trans-apical in the rest. The median survival rate post TAVI was 3.4 years, (95% CI: 2.5-4.4), and the survival rate for 1 to 5 years was 83%, 74%, 53%, 42% and 35% respectively. In the multivariate analysis, chronic obstructive pulmonary disease, (HR 2.17; 95% CI: 1.18-3.70), and latest moderate paravalvular regurgitation, (HR 2.98; CI: 1.44-6.17), were associated with increased mortality.
The aortic valve area increased from a mean baseline of 0.62 ± 0.17 cm² to an average of 1.67 ± 0.41 cm² immediately post TAVI and then 1.4 ± 0.25 cm2 at 5 years, decreasing 0.06 cm2/year, (p<0.01). The mean gradient increased with time at a rate of 0.27 mmHg/year, (p = 0.06), with no difference between the valves used. The average paravalvular aortic regurgitation was 11.4% immediately post TAVI, decreasing to 5.7% per year until 0% at 3 years.
None of the patients presented aortic stenosis or severe aortic regurgitation in evolution and only one patient showed endocarditis but after performing aortic valve replacement the patient progressed well. Prior moderate to severe mitral regurgitation was 48% but improved to 26% at follow-up. The 5 year heart failure class III-IV was 5% with an ejection fraction of 56%.
Conclusion:
The clinical outcome at 5 years post successful TAVI implantation was favorable as well as the hemodynamic results with only 3.4% suffering moderate valve dysfunction. No patients developed severe stenosis or paravalvular insufficiency.
Commentary:
The evolution of TAVI after 5 years is favorable assuming the high mortality risk of treated patients that without this strategy would be about 50% a year. Chronic obstructive pulmonary disease and moderate paravalvular insufficiency was associated with a shorter survival rate. There was no failure of the implanted valve with improved hemodynamic parameters and a good quality of life.
Courtesy by Dr Carlos Fava.
Interventional Cardiologist.
Favaloro Foundation. Argentina
Dr. Carlos Fava para SOLACI.ORG