TAVI is increasingly used but few data exist on longterm outcome. We analyzed 7-year outcome after TAVI and its predictive factors of late death.

Between 2006 and 2011, 280 consecutive high-risk patients (EuroScore 22±13%) underwent TAVI in our institution. Mean age was 82±9 years and 85% were in NYHA class III-IV.

Procedural success was achieved in 265 patients (95%). At 30 days, 29 patients were dead (cardiovascular related death in 10, procedure- related death in 10 and septic shock in 9). We focused on the 251 patients discharged alive after TAVI to analyze long-term outcome. Follow-up was complete in 99.6% of patients. During a mean follow-up of 4.1±0.2 years, 153 patients died, more than half of deaths being noncardiac.

Overall 7-year survival rate was 25±5%. We identified 3 preprocedural predictive factors of late mortality in multivariate analysis: cancer (p=0.01), NYHA class III-IV (p=0.03), higher creatinin level (p=0.004) and 5 post-procedural factors: paraprosthetic aortic regurgitation ≥2/4 (p=0.04), mean aortic gradient post TAVI (p=0.01), higher systolic PAP (p=0.03), low output/heart failure (p=0.01) and post-TAVI arrhythmias (p=0.004). Whereas conduction disorders are more frequent after TAVI (29% of cases in this series) and may often lead to pace-maker implantation, only post-TAVI arrhythmias (supraventricular in 32 patients or ventricular in 4) were predictive of late mortality.

Finally, in the 98 survivors, 2 out of 3 patients were in NYHA class I-II at last follow-up.

At 7-year follow-up after TAVI, the survival rate was 25% and most patients had few or no symptoms. The predictive factors of late mortality emphasized the weight of comorbidities. Particular awareness is needed toward the occurrence of post-TAVI arrhythmias which identifies high-risk patients.

The author hereby declares no conflict of interest