Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Abstract

BackgroundTranscatheter aortic valve implantation (TAVI) is indicated for patients with aortic stenosis who are intermediate‐high surgical risk. Although all‐cause mortality rates after TAVI are established, survival attributable to the procedure is unclear because of competing causes of mortality. The aim was to report relative survival (RS) after TAVI, which accounts for background mortality risks in a matched general population.Methods and ResultsNational cohort data (n=6420) from the 2007 to 2014 UK TAVI registry were matched by age, sex, and year to mortality rates for England and Wales (population, 57.9 million). The Ederer II method related observed patient survival to that expected from the matched general population. We modelled RS using a flexible parametric approach that modelled the log cumulative hazard using restricted cubic splines. RS of the TAVI cohort was 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. By 1‐year follow‐up, mortality hazards in the >85 years age group were not significantly different from those of the matched general population; by 3 years, survival rates were comparable. The flexible parametric RS model indicated that increasing age was associated with significantly lower excess hazards after the procedure; for example, by 2 years, a 5‐year increase in age was associated with 20% lower excess mortality over the general population.Conclusions RS after TAVI was high, and survival rates in those aged >85 years approximated those of a matched general population within 3 years. High rates of RS indicate that patients selected for TAVI tolerate the risks of the procedure well.

A 91-year-old woman with severe aortic stenosis successfully underwent maintenance hemodialysis via arteriovenous fistula after transcatheter aortic valve implantation: a case report with literature review

“…Although TAVI is a less invasive treatment than aortic valve replacement, TAVI itself has several risks, such as hemorrhage with vascular damage, embolic stroke, severe conduction abnormalities with left bundle branch block, or complete AV block, paravalvular leakage, and infective endocarditis [15]. However, the relative survival after TAVI is high, and survival rates in those aged > 85 years are approximately those of a matched general population within 3 years [3]. TAVI does not seem to bear an increased risk for patients with CKD stage G3-5 [4].…”

“…Transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of high-risk patients with severe AS. The relative survival after TAVI is high, and survival rates in those aged > 85 years are approximately those of a matched general population within 3 years [3]. TAVI is feasible in patients with not only chronic kidney disease (CKD) stage G3-5 [4] but also CKD stage G5D [5].…”

High-Sensitivity C-Reactive Protein in Transcatheter Aortic Valve Implantation: Prognostic Biomarker and New Potential Therapeutic Avenue

“…6 In a study analyzing the mortality rate in 6,420 patients undergoing TAVI (UK registry) compared to a matched general population, it was found that relative survival after TAVI was high, corresponding to 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. 7 Increasing age was associated with significantly lower excess hazards after TAVI, with survival rates in patients ages > 85 years approximated those of a matched general population within 3 years. In view of current evolution, it is thus very likely that TAVI will progressively supplant SAVR for AS patients who are eligible for both procedures.…”

“…This observation might corroborate the data from the CENTER collaboration study showing that patients with stroke had more frequently documented new-onset atrial fibrillation. 7 Similarly, as in the VISTA-16 study on ACS patients, 17 it would be interesting to determine if, in addition to initial hsCRP level, serial monitoring of hsCRP levels post-TAVI could further help identify patients at greater risk of postprocedural cardiovascular events or death, both on the short and long term. In TAVI patients, it remains to be determined whether hsCRP level represents a surrogate marker of inflammation or whether it should be considered as a direct biological target.…”

Pakistan Following Foot Prints of Developed World in Structural Interventions: Experience of Transcatheter Aortic Valve Implantation Reported First Time

“…Subsequently, the duration of hospitalization was also lower in TAVI group as compared to SAVR group (eight days vs. 12 days, p< 0.001) [ 12 ]. Since TAVI involve high-risk patients, so all cause 30 days, one year and three years observed survival estimates are lower, which are 94.7%, 83.4% and 64.5%, respectively [ 13 ].…”