P4394Long-term outcomes after Transcatheter Aortic Valve Implantation for high surgical risk patients with aortic stenosis: prognostic factors from a single center

Background: Transcatheter aortic valve Replacement (TAVR) has become the standard of care extreme surgical risk patients with symptomatic severe aortic stenosis and an alternative to open surgery in those deemed high risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes. The purpose of the present study was to analyze the survival and the factors predicting mortality after TAVI with the CoreValve prosthesis. Methods: From April 2008 to December 2016, the CoreValve prosthesis was implanted in 582 patients with symptomatic severe aortic stenosis with deemed high risk. Results: The mean age was 79.4±6.9 years. The logistic EuroSCORE and STS score were 17.5±12% and 7.3±5%, respectively. The implantation success rate was 98.9%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction or stroke had a rate of 14%. The late mortality (beyond 30 days) was 32.1%. Survival at 1, 2, 3, 4 y 5 years were 83.3%, 78.3%, 71.8%, 60.7% and 50.3%% respectively, after a mean follow-up of 36.5±25 months. The NYHA functional class improved from 3.1±0.6 to 1.77±0.7 in the follow-up. The predictors of cumulative mortality were: Charlson index [HR 1.2 (95% CI 1.08–1.336), p=0.001], Acute Kidney Injury [HR 1.94 (95% CI 1.203–3.141), p=0.007], Frailty [HR 2.33 (95% CI 1.43–3.817), p=0.001] and protective factors were a higher Karnosfky index [HR 0.987 (95% CI 0.976–0.998) p=0.002] and Ejection Fraction [HR 0.372 (95% CI 0.203–0.681), p=0,001]