Outcomes and Predictors of Mortality AfterTranscatheter Aortic Valve Implantation: results of theBrazilian Registry

ABSTRACT

The study sought to evaluate outcomes and predictors of mortality after transcatheteraortic valve implantation (TAVI). Background: TAVI registries can reliablyaddress outcomes and issues that adversely affect results in real-life. Methods: Allendpoints and complications were analyzed according to Valve Academic ResearchConsortium-2 criteria. Results: Between January 2008 and January 2013, 418 patientsunderwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoralapproach was used in 96.2% of the procedures. The CoreValve and Sapien XTprosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortalityat 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease(COPD) (HR 3.50), acute kidney injury (AKI) (HR 3.07), stroke (HR 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR 2.76) emerged as independent predictors ofoverall mortality. COPD (OR 3.00), major vascular complications (OR 7.99) and devicemalpositioning (OR 6.97) were predictors of early ( 30 days) mortality, while COPD (HR2.68), NYHA class III/IV (HR 3.04), stroke (HR 4.15), AKI (HR 2.44) and moderate/severePVR (HR 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram(TEE) to monitor the procedure was found to be a protective factor againstoverall (HR 0.57) and late (HR 0.47) mortality. Conclusion: This multicenter registryreflected a real-life national TAVI experience. Comorbidities, periprocedural complicationsand moderate/severe PVR were associated with increased mortality and the useof TEE to monitor the procedure acted as a protective factor.