Valvular and Congenital Heart Disease Causes and timing of death during long-term follow-up after transcatheter aortic valve replacement

Methods We enrolled 874 consecutive patients who underwent TAVR at 3 centers using all approved bioprostheses and different access routes. Clinical outcomes during follow-up were defined according to the Valve Academic Research Consortium 2 definitions. Causes of deaths were carefully investigated. Results Mean logistic European System for Cardiac Operative RiskEvaluation was 23.5% ± 15.3%; Society of Thoracic Surgery score, 9.0% ± 8.2%. The Corevalve (Medtronic, Minneapolis, MN) was used in 41.3%; the Edwards Sapien (Edwards Lifesciences Inc., Irvine, CA) in 57.3%. Vascular accesswas transfemoral in 75.7%. In-hospital mortality was 5.0%. Cumulativemortalityrates at1to3years were12.4%,23.4%,and31.5%,respectively.Landmarkanalysisshowedasignificantly higherincidence ofcardiovascular(CV)death in thefirst 6months of follow-upand asignificantlyhigherincidenceofnon-CVdeath thereafter. At Cox regression analysis, the independent predictors of in-hospital mortality were acute kidney injury grades 2 to 3 (hazard ratio [HR] 3.41) life-threatening bleeding (HR 4.26), major bleeding (HR 4.61), and myocardial infarction (HR 3.89). The independent predictors of postdischarge mortality were chronic obstructive pulmonary disease (HR 1.48), left ventricular ejection fraction at discharge (HR 0.98), and glomerular filtration rate b30 mL/min per 1.73 m 2 (HR 1.64). Conclusions Around a third of patients treated with TAVR in daily practice die within the first 3 years of follow-up. Early mortality is predominantly CV, whereas late mortality is mainly non-CV, and it is often due to preexisting comorbidity. (Am Heart J 2014;168:798-806.) Transcatheter aortic valve replacement(TAVR) has been shown to be noninferior to surgical aortic valve replacementin patients at high surgical risk, 1 and superior to medical treatmentininoperablepatientswithsevereaorticstenosis. 2 As a consequence, it has been rapidly adopted in clinical practice. 3