5-Year Outcomes After Transcatheter Aortic Valve Implantation With CoreValve Prosthesis

In this manuscript the authors describe their findings in a retrospective review of prospectively obtained 5-year follow up data on 353 patients undergoing transcatheter aortic valve implantation (TAVI) with the CoreValve prosthesis in 8 Italian centres.Transfemoral access was used in 317 patients (89.8%); in the rest of the patients in whom the transfemoral approach was  not feasible, a trans-subclavian access was employed. During follow-up, there were 241 re-hospitalizations for cardiovascular reasons in 164 (46%) patients. Acute heart failure was the most frequently reason reported (42.7%), followed by requirement of permanent pacemaker implantation (17.4%). On transthoracic echocardiography, mean pressure gradients decreased from 55.6 ±16.8 mm Hg (pre-TAVI) to 10.3±6.5 mm Hg (in-hospital post-TAVI) (p < 0.001). Five-year survival was 45% and freedom from re-hospitalization for cardiac reasons was 54%. Signs of prosthetic failure were observed in 15 patients (4.2%). The presence of moderate or severe paravalvular regurgitation after TAVI was associated with increased late mortality. The authors concluded that the procedure appears to be an adequate and lasting resolution of aortic stenosis in selected high-risk patients.