Transcatheter Aortic Valve Implantation - Which Determinants of Outcome Remain?

Objectives: TAVI has advanced to an established treatment option for high- risk patients. The present study evaluated determinants of outcome in a mono-centric real life setting.

Patients and Methods: Since 2008 1.171 patients underwent catheter-based aortic valve implantation. Modes of access were transfemoral in 643 patients (54.9%) and transfemoral in 528 patients (45.1%). Used devices were Medtronic CoreValve™ (n = 523), Edwards SAPIEN™/XT™/3™ (n = 485), Symetis Acurate™ (n = 100), JenaValve™ (n = 56), Direct Flow Medical™ (n = 5) and SJM Portico™ (n = 2). Mean patient's age was 82.2 ± 5.1 years and the logistic EuroSCORE averaged 19.6 ± 14.1% (range 3.0 to 84%). Pre-, intra- and postoperative factors were analyzed concerning their impact on hospital and further outcome. Mean follow-up was 327 ± 344 days, ranging from 13 to 1711 days.

Results: Intraoperatively 6 patients died (0.5%). Hospital mortality was 4.3%. During further follow-up 120 patients died (13.3%). 1-, 2-,3- and 4-years survival rates were 92.6%, 84.8%, 69.7% and 59.6%, respectively. Multivariate analysis identified poor LV-EF < 30% (p = 0.044), postoperative reintubation (p< 0.001), postoperative stroke (p = 0.002), postoperative dialysis (p = 0.003) as risk factors for hospital mortality. Multivariate factors for late mortality were poor LVEF < 30% (p = 0.010), chronic kidney disease (p = 0.035), presence of atrial fibrillation (0.019), postoperative reintubation (p< 0.01) and postoperative stroke (p< 0.01).

Conclusion: The hospital outcome after TAVI was rather related to postoperative morbidity than to preoperative factors. In contrast, long-term survival was very well influenced by preoperative factors. Accordingly, TAVI seems to uncouple hospital mortality from the classic risk factors. This might be a result from an assumable selection bias during the TAVI-screening process.