Long term outcomes of transcatheter aortic valve implantation (TAVI): a systematic review of 5-year survival and beyond

Abstract

Background: Transcatheter aortic valve implantation/replacement (TAVI/TAVR) is becoming more frequently used to treat aortic stenosis (AS), with increasing push for the procedure in lower risk patients. Numerous randomized controlled trials have demonstrated that TAVI offers a suitable alternative to the current gold standard of surgical aortic valve replacement (SAVR) in terms of short-term outcomes. The present review evaluates long-term outcomes following TAVI procedures.

Methods: Literature search using three electronic databases was performed up to June 2017. Studies which included 20 or more patients undergoing TAVI procedures, either as a stand-alone or concomitant procedure and with a follow-up of at least 5 years, were included in the present review. Literature search and data extraction were performed by two independent researchers. Digitized survival data were extracted from Kaplan-Meier curves in order to re-create the original patient data using an iterative algorithm and subsequently aggregated for analysis.

Results: Thirty-one studies were included in the present analysis, with a total of 13,857 patients. Two studies were national registries, eight were multi-institutional collaborations and the remainder were institutional series. Overall, 45.7% of patients were male, with mean age of 81.5±7.0 years. Where reported, the mean Logistic EuroSCORE (LES) was 22.1±13.7 and the mean Society of Thoracic Surgeons (STS) score was 9.2±6.6. The pooled analysis found 30-day mortality, cerebrovascular accidents, acute kidney injury (AKI) and requirement for permanent pacemaker (PPM) implantation to be 8.4%, 2.8%, 14.4%, and 13.4%, respectively. Aggregated survival at 1-, 2-, 3-, 5- and 7-year were 83%, 75%, 65%, 48% and 28%, respectively.

Conclusions: The present systematic review identified acceptable long-term survival results for TAVI procedures in an elderly population. Extended follow-up is required to assess long-term outcomes following TAVI, particularly before its application is extended into wider population groups.

Keywords: TAVI; Transcatheter aortic valve implantation; long-term; survival; systematic review.

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1

Timeline of publication rate annotated with significant events since the introduction of TAVI. Number of publications by year extracted from PubMed. TAVI, transcatheter aortic valve implantation; TAVR, transcatheter aortic valve replacement.

Figure 2

Aggregated long-term survival of patients receiving transcatheter aortic valve replacement. The expected survival curve for a general-population 82-year-old (calculated from the national life tables relevant to the included studies) is also plotted.

Figure 3

Long-term survival of patients receiving transcatheter aortic valve replacement, stratified according to high risk (logistic EuroSCORE >20, in red) or moderate risk (logistic EuroSCORE ≤20, in blue). LES, logistic EuroSCORE.

Figure S1

PRIMSA flow chart detailing the literature search process for TAVI outcomes at 5 years and beyond.

Figure S2

Survival of TAVI patients stratified by study quality according to our modified Canadian IHE guideline. IHE, Institute for Health Economics, Canada.