Author/Authors :
Rodés-Cabau، نويسنده , , Josep and Webb، نويسنده , , John G. and Cheung، نويسنده , , Anson and Ye، نويسنده , , Jian and Dumont، نويسنده , , Eric and Osten، نويسنده , , Mark and Feindel، نويسنده , , Christopher M. and Natarajan، نويسنده , , Madhu K. and Velianou، نويسنده , , James L. and Martucci، نويسنده , , Giussepe and DeVarennes، نويسنده , , Benoît and Chisholm، نويسنده , , Robert and Peterson، نويسنده , , Mark and Thompson، نويسنده , , Christopher R. and Wood، نويسنده , , David and Toggweiler، نويسنده , , Stefan and Gurvitch، نويسنده , , Ronen and Lichtenstein، نويسنده , , Samuel V. and Doyle، نويسنده , , Daniel and DeLarochellière، نويسنده , , Robert and Teoh، نويسنده , , Kevin and Chu، نويسنده , , Victor and Bainey، نويسنده , , Kevin and Lachapelle، نويسنده , , Kevin and Cheema، نويسنده , , Asim and Latter، نويسنده , , David and Dumesnil، نويسنده , , Jean G. and Pibarot، نويسنده , , Philippe and Horlick، نويسنده , , Eric، نويسنده ,
Abstract :
Objectives
tudy 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.
ound
ew data exist on the long-term outcomes associated with TAVI.
s
as 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.
s
ean 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.
sions
imately 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.
