Late mortality after TAVR largely linked to noncardiac causes
medwireNews: Late mortality following transcatheter aortic valve replacement (TAVR) is predominantly related to noncardiac causes, with comorbid conditions having a major impact on survival, results from the FRANCE-2 registry study suggest.
Martine Gilard (Brest University Hospital, France) and colleagues found that 3 years after TAVR, the total mortality rate was 42.0% but the cardiovascular mortality rate was just 17.5% (19.3% after independent adjudication).
In multivariate analyses, factors predicting 3-year mortality included male gender, low body mass index, atrial fibrillation, dialysis, higher logistic EuroSCORE and New York Heart Association functional class III or IV. Lower mortality rates occurred in patients undergoing TAVR with a transfemoral approach compared with a transapical or subclavian approach.
“As with other predictive models of mortality after TAVR, we see the major impact of comorbid conditions, both cardiac and noncardiac, on post-TAVR survival”, explains John Carroll (University of Colorado, Aurora, USA) in an accompanying editorial comment.
The analysis included 4085 patients from 34 hospitals across France and Monaco in the FRANCE-2 registry; TAVR approaches were transfemoral in 72.9% of patients and transapical in 72.9%.
“[T]his registry provides accurate estimations and represents the largest available database on late results of TAVR”, note the authors in the Journal of the American College of Cardiology.
Carroll says some previous studies reported higher cardiovascular mortality rates than FRANCE-2, but he emphasizes that there is general agreement that the majority of patients will have died within 5 years of TAVR.
“Survival benefits from TAVR are important; however, improved or maintained functional status, quality of life, and freedom from hospitalization are other benefits that become extremely important for judging the value of TAVR”, he explains.
Looking to the future, Carroll predicts that there will be a substantial increase in the number of patients undergoing TAVR as the elderly population increases.
He highlights that when TAVR is performed without major complications, the procedure “returns the patient to a prognosis and a day-to-day existence defined by their age, sex, other diseases, frailty, socioeconomic status, and patient reported health status”.
The study authors conclude: “The sustained clinical improvement and low rate of clinical events after the first month contribute to strengthening the current indication for TAVR in high-risk patients.”
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