2381/41231
Glen P. Martin
Glen P.
Martin
Matthew Sperrin
Matthew
Sperrin
William Hulme
William
Hulme
Peter F. Ludman
Peter F.
Ludman
Mark A. de Belder
Mark A.
de Belder
William D. Toff
William D.
Toff
Oras Alabas
Oras
Alabas
Neil E. Moat
Neil E.
Moat
Sagar N. Doshi
Sagar N.
Doshi
Iain Buchan
Iain
Buchan
John E. Deanfield
John E.
Deanfield
Chris P. Gale
Chris P.
Gale
Mamas A. Mamas
Mamas A.
Mamas
National Institute of Cardiovascular Outcomes Research (NICOR)
National Institute of Cardiovascular Outcomes
Research
Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?
University of Leicester
2018
aortic stenosis
mortality
relative survival
transcatheter aortic valve implantation
2018-02-21 14:10:29
Journal contribution
https://figshare.le.ac.uk/articles/journal_contribution/Relative_Survival_After_Transcatheter_Aortic_Valve_Implantation_How_Do_Patients_Undergoing_Transcatheter_Aortic_Valve_Implantation_Fare_Relative_to_the_General_Population_/10217021
BACKGROUND: Transcatheter 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 RESULTS: National 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. CONCLUSIONS: RS 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.