Failure is Fatal! Which Determinants of Outcome Remain after Transcatheter Aortic Valve Implantation?

Markus Mach ¹, Manuel Wilbring ², Konstantin Alexiou ², Utz Kappert ², Martin Grabenwöger ¹, Klaus Matschke ²

¹ Hospital Hietzing, Department of Cardiovascular Surgery, Vienna, Austria; ² University Heart Center Dresden, Dresden, Germany;

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–B

Abstract

Objectives

To the present, detailed knowledge about factors predisposing adverse outcomes of high-risk subgroups remains scarce. The present study gives a detailed analysis of a large TAVI cohort.

Patients and Methods

Since 2009, 1.861 consecutive patients underwent TAVI in two study centers. Mean patient’s age was 80.8 +/- 5.6. Mean follow-up was 2.92 years, ranging up to 6.8 years. Data were retrospectively analyzed out of the hospital’s database. A uni- and multivariate analysis of risk factors for mortality during primary hospital-stay and further follow-up was performed.

Results

Hospital mortality was 4.1%. Survival rates for 1-, 2- and 5-years were 96%, 86,8% and 46,2% respectively . Univariate risk factors for hospital mortality were LV-EF <30% (p=0.03), extracardiac arteriopathy (p=0.023), chronic kidney disease (p=0.002), postoperative LCOS (p<0.01), re-exploration (p<0.01), respiratory failure (p<0.01), postoperative stroke (p<0.01), CVVH (p<0.01), prolonged ventilation (p<0.01), transfusion (p<0.01), prolonged ICU-stay (p<0.01). After multivariate analysis respiratory failure needing reintubation (HR 2.3 +/- 0.4; p<0.01), postoperative stroke (HR 1.4 +/- 0.6; p=0.02) and postoperative renal failure needing CVVH (HR 1.1 +/- 0.4; p<0.01) remained as factors for hospital mortality. Univariate risk factors for mortality during follow-up of the hospital survivors were  postoperative stroke (p<0.01), postoperative CVVH (p<0.01), transfusion (p<0.01), postoperative respiratory failure needing reintubation (p<0.01), postoperative stroke (p<0.01). After multivariate analysis pulmonary hypertension (HR 2.8 +/- 0.2; p<0.01) and postoperative stroke (HR 1.7 +/- 0.7; p=0.02) remained as significant factors for mortality during follow-up.

Conclusions

Hospital mortality of TAVI-patients is decoupled from patients baseline characteristics. Significant factors for hospital mortality mainly were generated out of post-procedural complications. Different patterns were observed for long-term survival. Generally, TAVI provides good results in this particular high-risk subgroup. Further investigations are needed to clearly identify patients benefiting or not-benefiting from TAVI.