UK experience shows nearly half of patients alive 5 years after TAVR

PARIS — Findings from the UK TAVI Registry have concluded that more than 60% of patients treated with transcatheter aortic valve replacement survived to 3 years and nearly 50% survived to 5 years after the procedure.

The study was presented at EuroPCR by Neil Moat, MD, and Alison Duncan, MD, of the Royal Brompton Hospital in London, who reported the 3- and 5-year clinical outcomes after TAVR, using data from UK TAVI Registry.

A key strength of the UK TAVI Registry, Moat said at a press conference, is that it has captured every TAVR procedure in the United Kingdom since the first in 2007. “It now contains nearly 5,000 patient records,” he said. “The other big strength of the registry is that all deaths are captured in the United Kingdom and reported to a national body, so we are able to track late mortality. This is part of an ongoing work to track late outcomes following the procedure.”

In all, the study included data collected prospectively on the 870 patients implanted up to the end of 2009. The minimum follow-up was 3.5 years and the maximum follow-up was 6.4 years, which Moat said is unique in reports of TAVR. Mortality status was reported as of July 2013 and tracking was achieved in 95.2% patients.

At 3 years, 61.6% of patients were alive and at 5 years, 48.4% were alive.

“That is pretty encouraging data given the fact that these were the first TAVRs done in the UK and represented every units first experience with TAVR,” Moat said.

Baseline characteristics that independently predicted mortality at 3 years were atrial fibrillation (multivariate P=.018), chronic obstructive pulmonary disease (COPD; P=.034), Cr >200 mcg/mmol (P=.008) and EuroSCORE ≥18.5 (P=.012). Five-year predictors of mortality included age (P=.001), diabetes (P=.01), AF (P=.009), COPD (P=.022), Cr >200 mcg/mmol (P=.002) and EuroSCORE ≥18.5 (P=.026).

“When we looked at vascular complications, paravalvular [aortic regurgitation], valve type used and requirement for a pacemaker, none of these things impacted survival at 3 or 5 years,” Moat added.

Transfemoral access vs. non-transfemoral access was a predictor of a better outcome in the univariate analysis, but was not an independent predictor of late survival.

“What these data are telling us is that patients undergoing TAVR are not dying late after the procedure. The message here is that long-term outcome is predominantly determined by patient factors, disease process and comorbidities,” Moat concluded. “Procedural complications, such as paravalvular leak, did not influence long-term outcome. Also, these data suggest that patients are not experiencing a high rate of late TAVR-related complications that might affect late mortality.”– by Brian Ellis

For more information:

Moat N. Hot line: Trial updates and registries. Presented at: EuroPCR; May 20-23, 2014; Paris.

Disclosure: Moat reports no relevant financial disclosures.