Survival data encouraging after TAVI in high-risk patients

Moat NE. J Am Coll Cardiol. 2011;58:2130-2138.

Outcomes after transcatheter aortic valve implantation appear encouraging for high-risk patients with severe aortic stenosis, according to researchers who reported results of the U.K. TAVI Registry.

Neil E. Moat, MBBS, MS, of the Royal Brompton and Harefield National Health Service Foundation Trust, and colleagues conducted a study to examine characteristics of a “real-world population” treated with transcatheter aortic valve implantation (TAVI) and evaluate mid- to long-term survival. The U.K. TAVI Registry reported outcomes of all TAVI procedures performed. The researchers focused on 870 patients who underwent 877 implantations from January 2007 to December 2009.

Survival was 92.9% in the first month after implantation, but significantly decreased to 78.6% at 1 year and 73.7% at 2 years.

“Although 30-day mortality was acceptable, there was a significant attrition between 30 days and 12 months, predominantly in the highest-risk cohort,” the researchers wrote. According to results, after 1 year, the rate of reduction in survival decreased markedly.

Several factors significantly adversely affected survival, including renal dysfunction, presence of CAD and a nontransfemoral approach, according to a univariate model. Left ventricular function (ejection fraction <30%), moderate/severe aortic regurgitation and chronic obstructive pulmonary disease were the only independent predictors of survival in a multivariate model.

“These data, in conjunction with those from other registries and from the PARTNER trial, suggest that it would be appropriate to compare TAVI with surgical [aortic valve replacement] in the setting of a randomized trial in a less high-risk cohort of patients,” the researchers concluded.

Disclosure: Dr. Moat is a consultant to Medtronic and has received honoraria from Edwards LifeSciences and Abbott.

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