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Survival, Predictive Factors, and Causes of Mortality Following Transcatheter Aortic Valve Implantation

Alassar, Aiman MRCS*; Roy, David MD; Valencia, Oswaldo MD*; Brecker, Stephen FRCP; Jahangiri, Marjan FRCS(CTh)*

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: September/October 2013 - Volume 8 - Issue 5 - p 359–363
doi: 10.1097/IMI.0000000000000024
Original Articles

Objective Transcatheter aortic valve implantation (TAVI) is considered the standard of care for patients with severe symptomatic aortic stenosis unsuitable for surgery. However, short- and long-term mortality after TAVI are still relatively high. The aim of this study was to establish survival, predictive factors, and causes of mortality after TAVI at early and midterm follow-up.

Methods Between December 2007 and May 2012, a total of 119 patients with symptomatic severe aortic stenosis underwent 121 TAVI procedures. The mean ± SD age was 81 ± 9 years, and 59% were men. The mean ± SD logistic European System for Cardiac Operative Risk Evaluation was 22 ± 15. Seventy-five patients (63%) were in New York Heart Association functional class III to IV. The transfemoral approach was used in 76% of the patients. One hundred ten patients (91%) had the CoreValve prosthesis, and 11 (9%) had an Edwards SAPIEN valve. Baseline characteristics, procedural complications, and outcomes were collected prospectively. Clinical outcomes were defined according to the Valve Academic Research Consortium criteria. Follow-up was completed for 100% of the patients at a median of 1.3 years (range, 0–4.5).

Results The total number of deaths was 36 (30%). One-month mortality was 4.2%. Actuarial survival was 83.2%, 76.5%, and 68.2% at 1, 2, and 3 years, respectively. Acute kidney injury occurred in 12.3% of the patients, none of whom required dialysis during hospitalization. Twenty-one patients (17.6%) had new conduction abnormalities that required permanent pacemaker implantation before hospital discharge. The incidence of major vascular injury and stroke was 2.4% and 4.1%, respectively. Survival was significantly adversely affected by preprocedural left ventricular dysfunction (P = 0.04), history of atrial fibrillation (P = 0.03), prior heart block (P < 0.01), and critical preoperative state (P < 0.01). Twelve (33%) of the 36 deaths were due to bronchopneumonia. In 12 (33%) of the 36 patients who died, mortality was related to cardiac causes. When a death occurred within the first 30 days, it was mainly cardiac in nature (80%). Twelve patients (34%) died because of a variety of other reasons such as pulmonary embolism, stroke, cancer, renal failure, and sepsis.

Conclusions Preprocedural left ventricular dysfunction, atrial fibrillation, and heart block are independent predictive factors of all-cause mortality. Early mortality was mainly cardiac in origin. Most of the late deaths were caused by noncardiac reasons, with bronchopneumonia being reported as the most common cause of late mortality.

From the *Department of Cardiac Surgery, and †Department of Cardiology, St. George’s Hospital, London, UK.

Accepted for publication September 16, 2013.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30 – June 2, 2012, Los Angeles, CA USA.

Disclosures: Stephen Brecker, FRCP, is a consultant for Medtronic, Inc, Minneapolis, MN USA. Aiman Alassar, MRCS; David Roy, MD; Oswaldo Valencia, MD; and Marjan Jahangiri, FRCS(CTh), declare no conflicts of interest.

Address correspondence and reprint requests to Marjan Jahangiri, FRCS(CTh), Department of Cardiac Surgery, St. George’s Hospital, Blackshaw Rd, London SW17 0QT UK. E-mail: marjan.jahangiri@stgeorges.nhs.uk.

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery