Long-term outcomes after transcatheter aortic valve implantation from a single high-volume center (The Milan Experience)

Neil Ruparelia, Azeem Latib, Nicola Buzzatti, Francesco Giannini, Filippo Figini, Antonio Mangieri, Damiano Regazzoli, Stefano Stella, Alessandro Sticchi, Hiroyoshi Kawamoto, Akihito Tanaka, Eustachio Agricola, Fabrizio Monaco, Alessandro Castiglioni, Marco Ancona, Micaela Cioni, Pietro Spagnolo, Alaide Chieffo, Matteo Montorfano, Ottavio AlfieriAntonio Colombo

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Transcatheter aortic valve implantation (TAVI) is now the treatment of choice for patients with symptomatic aortic stenosis who are inoperable or with high surgical risk. Data with regards to contemporary clinical practice and long-term outcomes are sparse. To evaluate temporal changes in TAVI practice and explore procedural and long-term clinical outcomes of patients in a contemporary "real-world" population, outcomes of 829 patients treated from November 2007 to May 2015, at the San Raffaele Scientific Institute, Milan, Italy, were retrospectively analyzed. Median follow-up was 568 days, with the longest follow-up of 2,677 days. Overall inhospital mortality was 3.5%. During the study period, there was a trend toward treating younger, lower risk patients. Overall mortality rates were 3.5% (30 days), 14% (1 year), 22% (2 years), 29% (3 years), 37% (4 years), 47% (5 years), 53% (6 years), and 72% (7 years). The survival probability at 5 years was significantly higher in patients treated through the transfemoral (TF) route compared to other vascular access sites (log rank p <0.001). Non-TF vascular access and residual paravalvular leak ≥2 (after TAVI) were identified as independent predictors for both all-cause and cardiovascular mortality. No patient required further aortic valve intervention for TAVI prosthesis degeneration. In conclusion, there is a trend toward treating younger, lower-risk patients. Non-TF vascular access approach and ≥2 PVL after TAVI were identified as independent predictors for both overall and cardiovascular mortality with no cases of prosthesis degeneration suggesting acceptable durability.

Original languageEnglish (US)
Pages (from-to)813-819
Number of pages7
JournalAmerican Journal of Cardiology
Volume117
Issue number5
DOIs
StatePublished - Mar 1 2016
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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