Long-Term Outcomes After Transcatheter Aortic Valve Replacement: Meta-Analysis of Kaplan-Meier-Derived Individual Patient Data

Abstract

AbstractBackgroundTranscatheter aortic valve replacement (TAVR) is as an alternative treatment to surgical AVR, but the long-term outcomes of TAVR remain unclear. This study aimed to analyze long-term outcomes following TAVR using meta-analysis.MethodsA literature search was performed with MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar through December 2022; studies reporting clinical outcomes of TAVR with follow-up periods of ≥ 8 years were included. The outcomes of interest were overall survival and/or freedom from structural valve deterioration (SVD). Surgical risk was assessed with the Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. A subgroup analysis was conducted for intermediate-/high-surgical risk patients only.ResultsEleven studies including 5,458 patients were identified and analyzed. The mean age was 82.0 ± 6.5 years, and mean STS PROM score ranged from 2.9 to 10.6%. Survival rate at 5 and 10 years was 47.7% ± 1.4% and 12.1 ± 2.0%. Five studies including 1,509 patients were analyzed for SVD. Freedom from SVD at 5 and 8 years was 95.5 ± 0.7% and 84.9 ± 3.1%. Similar results for survival and SVD were noted in the subgroup analysis of intermediate-/high-risk patients.ConclusionsFollowing TAVR, approximately 88% of patients died within 10 years, whereas 85% were free from SVD at 8 years. These date suggest that baseline patient demographic have the greatest impact on survival, and SVD does not seem to have a prognostic impact in this population. Further investigations on longer-term outcomes of younger and lower-risk patients are warranted.What is new?-Meta-analysis of time-to-event data was performed to assess long-term outcomes following transcatheter aortic valve replacement in a large population.-Six studies, including 4,910 patients with follow-up periods of more than 20 years were identified and analyzed.-Nearly 88% of patients who underwent transcatheter aortic valve replacement died within 10 years, while 85% remained free from structural valve deterioration at 8 years.Perspective Statement What are the clinical implications?-This meta-analysis demonstrated excellent freedom from structural valve deterioration in intermediate- to high elderly risk patients.-Baseline patient characteristics correlated with high mortality at 10 years.-Further investigation into the outcomes in younger and lower-risk populations is imperative to evaluate the future expanded indications for transcatheter aortic valve replacement.