Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

William D. Toff¹  Iain Buchan²  Glen P. Martin²  Mamas A. Mamas²  Matthew Sperrin²  William Hulme²  Mark A. de Belder³  Oras Alabas⁴  Chris P. Gale⁴  John E. Deanfield⁵  Sagar N. Doshi⁶  Peter F. Ludman⁶  Neil E. Moat⁷ 

[1] Department of Cardiovascular Sciences, Clinical Sciences Wing, Glenfield General Hospital, University of Leicester, United Kingdom;Farr Institute, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, United Kingdom;James Cook University Hospital, Middlesbrough, United Kingdom;Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, United Kingdom;National Institute for Cardiovascular Outcomes Research, University College London, London, United Kingdom;Queen Elizabeth Hospital, Birmingham, United Kingdom;Royal Brompton and Harefield National Health Service Foundation Trust, London, United Kingdom;

关键词: aortic stenosis;    mortality;    relative survival;    transcatheter aortic valve implantation;   

DOI  :  10.1161/JAHA.117.007229

来源: DOAJ

【 摘 要 】

BackgroundTranscatheter aortic valve implantation (TAVI) is indicated for patients with aortic stenosis who are intermediate‐high surgical risk. Although all‐cause mortality rates after TAVI are established, survival attributable to the procedure is unclear because of competing causes of mortality. The aim was to report relative survival (RS) after TAVI, which accounts for background mortality risks in a matched general population. Methods and ResultsNational cohort data (n=6420) from the 2007 to 2014 UK TAVI registry were matched by age, sex, and year to mortality rates for England and Wales (population, 57.9 million). The Ederer II method related observed patient survival to that expected from the matched general population. We modelled RS using a flexible parametric approach that modelled the log cumulative hazard using restricted cubic splines. RS of the TAVI cohort was 95.4%, 90.2%, and 83.8% at 30 days, 1 year, and 3 years, respectively. By 1‐year follow‐up, mortality hazards in the >85 years age group were not significantly different from those of the matched general population; by 3 years, survival rates were comparable. The flexible parametric RS model indicated that increasing age was associated with significantly lower excess hazards after the procedure; for example, by 2 years, a 5‐year increase in age was associated with 20% lower excess mortality over the general population. ConclusionsRS after TAVI was high, and survival rates in those aged >85 years approximated those of a matched general population within 3 years. High rates of RS indicate that patients selected for TAVI tolerate the risks of the procedure well.

【 授权许可】

Unknown