Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?.pdf (1.16 MB)
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Relative Survival After Transcatheter Aortic Valve Implantation: How Do Patients Undergoing Transcatheter Aortic Valve Implantation Fare Relative to the General Population?

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journal contribution
posted on 21.02.2018, 14:10 by Glen P. Martin, Matthew Sperrin, William Hulme, Peter F. Ludman, Mark A. de Belder, William D. Toff, Oras Alabas, Neil E. Moat, Sagar N. Doshi, Iain Buchan, John E. Deanfield, Chris P. Gale, Mamas A. Mamas, National Institute of Cardiovascular Outcomes Research (NICOR)
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.

Funding

This work was funded by the Medical Research Council through the Health e‐Research Centre, University of Manchester (MR/K006665/1), and a grant through the North Staffordshire Heart Committee. We acknowledge the National Institute for Cardiovascular Outcomes Research who provided the UK TAVI registry extract for this study.

History

Citation

Journal of the American Heart Association , 2017, 6 (10)

Author affiliation

/Organisation/COLLEGE OF LIFE SCIENCES/School of Medicine/Department of Cardiovascular Sciences

Version

VoR (Version of Record)

Published in

Journal of the American Heart Association

Publisher

Wiley, American Heart Association: JAHA, American Stroke Association

eissn

2047-9980

Acceptance date

18/08/2017

Copyright date

2017

Available date

21/02/2018

Publisher version

http://jaha.ahajournals.org/content/6/10/e007229

Language

en