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Long-term durability of transcatheter aortic valve prostheses: results of a center.

Session Poster Session 4

Speaker Antonio Jesus Munoz Garcia

Event : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Intervention
  • Session type : Poster Session

Authors : E Munoz-Garcia (Malaga,ES), M Munoz-Garcia (Malaga,ES), A J Munoz Garcia (Malaga,ES), F Carrasco-Chinchilla (Malaga,ES), AJ Dominguez-Franco (Malaga,ES), JH Alonso-Briales (Malaga,ES), JM Hernandez-Garcia (Malaga,ES), JJ Gomez-Doblas (Malaga,ES), MF Jimenez-Navarro (Malaga,ES)

Authors:
E. Munoz-Garcia1 , M. Munoz-Garcia1 , A.J. Munoz Garcia1 , F. Carrasco-Chinchilla1 , A.J. Dominguez-Franco1 , J.H. Alonso-Briales1 , J.M. Hernandez-Garcia1 , J.J. Gomez-Doblas1 , M.F. Jimenez-Navarro1 , 1University Hospital Virgen de la Victoria, Department of Cardiology - Malaga - Spain ,

Topic(s):
Valvular Heart Disease: Intervention

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 2298

The durability of transcatheter heart valves and long-term clinical outcomes are unknown. The aim of this study was to evaluate clinical and hemodynamic outcomes between 5 to 9 years after Transcatheter Aortic Valve Implantation (TAVI).

Methods: Between April 2008 and December 2012, 305 patients underwent TAVI for the treatment of severe symptomatic aortic stenosis with the auto-expandable prosthesis.

Results: The mean age, logistic EuroSCORE and STS score were 79.3±6.5 years, 19.4±12% and 6.6±4% respectively. Mean aortic valve gradient decreased from 48.7±15 mm Hg to 8.9±4.3 mmHg after TAVI, to 11.1±9 mm Hg at 4 years, and 22.7±12 mmHg at 5 years (p for post-TAVI trend 0.03). Mean aortic valve area increased from 0.63±0.16 cm2 to 1.57±0.3cm2 after TAVI to 1.48±0.2 at 4 years and 0.97±0.3 cm2 at 5 years (p for post-TAVI trend 0.01). Mean left ventricular ejection fraction increased from 61.1±15% to 65.5±11% after TAVI, to 58.2±17% at 4 years and 60.7±8% at 5 years (p for post-TAVI trend 0.001).

Late mortality after a mean of 4.15±2.4 years 58% and in only 34.1% patients was cardiovascular mortality. Survival rates at 1 to 9 years were at 87.5%, 79%, 73.1%, 65.6%, 55.4%, 48.2%, 41.9%, 37.3% and 35.1% respectively. At 5 years, 3 patients had severe prosthetic valve dysfunction (severe stenosis and moderate transvalvular regurgitation). Median survival time after TAVI was 6 years (95% confidence interval [CI]: 5.89 to 6.28), and the risk of death was significantly increased in patients with frailty (adjusted hazard ratio [HR]: 1.864; 95% CI: 1.204 to 2.886), p=0.001, Charlson index [HR= 1.243 (95% CI 1.148–1.346), p<0.001], and left ventricular ejection fraction [HR= 1.012; (95% CI 1.001–1.024)p=0.044].

Conclusions: Our study demonstrated favorable long-term outcomes after TAVI. Signs of prosthetic valve failure were observed in 0.97% of patients

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