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Analysis of long-term survival following transcatheter aortic valve implantation from a single high-volume center.

by Escarcega, Ricardo O; Lipinski, Michael J; Baker, Nevin C; Magalhaes, Marco A; Minha, Sa'ar; Torguson, Rebecca; Chen, Fang; Ben-Dor, Itsik; Satler, Lowell F; Pichard, Augusto D; Corso, Paul J; Waksman, Ron.
Citation: American Journal of Cardiology. 116(2):256-63, 2015 Jul 15..Journal: The American journal of cardiology.ISSN: 0002-9149.Full author list: Escarcega RO; Lipinski MJ; Baker NC; Magalhaes MA; Minha S; Torguson R; Chen F; Ben-Dor I; Satler LF; Pichard AD; Corso P; Waksman R.UI/PMID: 25978977.Subject(s): Aged, 80 and over | Aortic Valve Stenosis/mo [Mortality] | *Aortic Valve Stenosis/su [Surgery] | District of Columbia/ep [Epidemiology] | Female | Follow-Up Studies | *Hospitals, High-Volume/sn [Statistics & Numerical Data] | Humans | Male | Postoperative Period | Prognosis | Retrospective Studies | Survival Rate/td [Trends] | Time Factors | *Transcatheter Aortic Valve Replacement/mo [Mortality]Institution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: http://dx.doi.org/10.1016/j.amjcard.2015.04.016 (Click here) Abbreviated citation: Am J Cardiol. 116(2):256-63, 2015 Jul 15.Local Holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - 2006.Abstract: Mortality after transcatheter aortic valve implantation (TAVI) has been reported to range up to 3 years. However, long-term mortality remains underexplored. The aims of this study were to determine long-term mortality in patients who undergo TAVI and to identify correlates of long-term death. From a single institution's prospectively collected TAVI database, all patients who underwent TAVI with a maximum follow-up duration of 5 years were analyzed. The population was analyzed on the basis of access route (transapical TAVI or transfemoral TAVI). Cox regression and Kaplan-Meier survival analysis were conducted. A total of 511 patients who underwent TAVI were included in the analysis (transapical TAVI n = 115, transfemoral TAVI n = 396). The mean Society of Thoracic Surgeons score was 9.6 +/- 4. Mortality at 30 days (18% vs 6%, p <0.001) and 1 year (32% vs 21%, p <0.01) was significantly increased in the transapical TAVI group. Long-term survival probability was <50% for the 2 approaches (log-rank p = 0.33). Vascular complications (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.38 to 3.33, p = 0.001), more than mild aortic insufficiency (HR 1.81, 95% CI 1.15 to 2.83, p = 0.01), atrial fibrillation (HR 1.87, 95% CI 1.36 to 2.57, p <0.001), and in-hospital stroke (HR 2.35, 95% CI 1.39 to 4.00, p = 0.002) were independently associated with long-term death. The survival probability of patients at high surgical risk versus those who were inoperable was similar in the long term (log-rank p = 0.53). In conclusion, the overall long-term survival of patients with aortic stenosis who were approved to undergo TAVI was <50% irrespective of access method. Strategies geared toward reducing in-hospital stroke, vascular complications, and aortic regurgitation are still needed, as these variables are correlates of long-term mortality.Copyright � 2015 Elsevier Inc. All rights reserved.

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