Friday, 29 March, 2024
HomeCardiologyFirst one-year TAVR mortality data

First one-year TAVR mortality data

Study results of one-year data for more than 12,000 patients who has trans-catheter aortic valve replacement (TAVR) in the US show an overall one-year death rate of 23.7% and a stroke rate of 4.1%, according to a study.

"Trans-catheter aortic valve replacement has become transformational for patients who need a new valve and are at high-risk for surgery or inoperable. But we have been lacking long-term data for this group of patients who are considering this procedure," says study lead author Dr David R Holmes Jr, a Mayo Clinic interventional cardiologist. "Before this study, we only had 30-day information. This is a milestone and will help us better guide patients and learn as physicians."

For the study, researchers used the Trans-catheter Valve Therapies Registry, developed by the Society of Thoracic Surgeons and the American College of Cardiology, combining 12,182 TAVR patient procedures performed from November 2011 through June 2013 and linking to Centres for Medicare and Medicaid Services administrative claims for one-year data using direct Medicare patient identifiers (name and social security numbers).

Other important results from the study are: median age of patients was 84 years old, and 52% of patients were female; 8% of patients were discharged directly to home; 30-day mortality was 7%; 4% of survivors were re-hospitalised only once; and 12.5% twice.

Characteristics significantly associated with 1-year mortality included advanced age, male sex, end-stage renal disease and severe chronic obstructive pulmonary disease. Compared with men, women had a higher risk of stroke.

The authors note that the rate of l-year mortality reported with this registry is similar to that in other comprehensive reports. "Although this study includes only patients considered to have high risks with AVR, the majority of this mortality does not represent peri-procedural complications, as 30-day mortality was only 7.0%. As such, this makes it imperative to focus on better prediction of the overall risks and benefits of the procedure, particularly given the existing comorbidities of the group of patients being considered for TAVR." They add that it may be possible to identify patients who may not benefit from this procedure and who should be counselled accordingly.

"Although 3 randomised trials and multiple single-centre and multicentre registry studies have been published, the profile and longer-term outcomes of US TAVR cases in routine clinical practice remains limited," the researchers write. "These findings should be helpful in discussions with patients undergoing TAVR."

TAVR received US Food and Drug Administration approval in 2011. It is used with increasing frequency for the treatment of severe aortic stenosis in patients who are at high or prohibitive risk for surgical aortic valve replacement, Holmes says.

[link url="http://newsnetwork.mayoclinic.org/discussion/jama-publishes-one-year-data-for-transcatheter-aortic-valve-replacement-procedure-in-u-s-patients/"]Mayo Clinic material[/link]
[link url="http://jama.jamanetwork.com/article.aspx?articleid=2190986"]JAMA abstract[/link]

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