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(Circulation. 2009;119:3009-3016.)
© 2009 American Heart Association, Inc.

Valvular Heart Disease

Transcatheter Aortic Valve Implantation

Impact on Clinical and Valve-Related Outcomes

John G. Webb, MD^*; Lukas Altwegg, MD^*; Robert H. Boone, MD; Anson Cheung, MD; Jian Ye, MD; Samuel Lichtenstein, MD, PhD; May Lee, MSc; Jean Bernard Masson, MD; Christopher Thompson, MD; Robert Moss, MD; Ron Carere, MD; Brad Munt, MD; Fabian Nietlispach, MD; Karin Humphries, PhD

From the Divisions of Cardiology and Cardiac Surgery, St Paul’s Hospital and the Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Correspondence to John Webb, MD, St. Paul’s Hospital, 1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6. E-mail webb{at}providencehealth.bc.ca

Received November 24, 2008; accepted April 6, 2009.

Background— Transcatheter aortic valve implantation is an alternative to open heart surgery in patients with aortic stenosis. However, long-term data on a programmatic approach to aortic valve implantation remain sparse.

Methods and Results— Transcatheter aortic valve implantation was performed in 168 patients (median age, 84 years) in the setting of severe aortic stenosis and high surgical risk. Access was transarterial (n=113) or, in the presence of small iliofemoral artery diameter, transapical (n=55). The overall success rate was 94.1% in this early experience. Intraprocedural mortality was 1.2%. Operative (30-day) mortality was 11.3%, lower in the transarterial group than the transapical group (8.0% versus 18.2%; P=0.07). Overall mortality fell from 14.3% in the initial half to 8.3% in the second half of the experience, from 12.3% to 3.6% (P=0.16) in transarterial patients and from 25% to 11.1% (P=0.30) in transapical patients. Functional class improved over the 1-year postprocedure period (P<0.001). Survival at 1 year was 74%. The bulk of late readmission and mortality was not procedure or valve related but rather was due to comorbidities. Paravalvular regurgitation was common but generally mild and remained stable at late follow-up. At a maximum of >3 years and a median of 221 days, structural valve failure was not observed.

Conclusions— Transcatheter aortic valve implantation can result in early and sustained functional improvement in high-risk aortic stenosis patients. Late outcome is determined primarily by comorbidities unrelated to aortic valve disease.

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CLINICAL PERSPECTIVE

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