Long‐term outcomes after transcatheter aortic valve replacement: Meta‐analysis of Kaplan−Meier‐derived data

Abstract

Background Transcatheter aortic valve replacement (TAVR) is as an alternative treatment to surgical AVR, but the long‐term outcomes of TAVR remain unclear.
Aims This study aimed to analyze long‐term outcomes following TAVR using meta‐analysis.
Methods A literature search was performed with MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar through November 2022; studies reporting clinical outcomes of TAVR with follow‐up periods of ≥8 years were included. The outcomes of interest were overall survival and/or freedom from structural valve deterioration (SVD). Surgical risk was assessed with the Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. A subgroup analysis was conducted for intermediate‐/high‐surgical risk patients only.
Results Eleven studies including 5458 patients were identified and analyzed. The mean age was 82.0 ± 6.5 years, and mean STS PROM score ranged from 2.9 to 10.6%. Survival rate at 5 and 10 years was 47.7% ± 1.4% and 12.1 ± 2.0%. Five studies including 1509 patients were analyzed for SVD. Freedom from SVD at 5 and 8 years was 95.5 ± 0.7% and 85.1 ± 3.1%. Similar results for survival and SVD were noted in the subgroup analysis of intermediate‐/high‐risk patients.
Conclusions Following TAVR, approximately 88% of patients died within 10 years, whereas 85% were free from SVD at 8 years. These date suggest that baseline patient demographic have the greatest impact on survival, and SVD does not seem to have a prognostic impact in this population. Further investigations on longer‐term outcomes of younger and lower‐risk patients are warranted.

Keywords: aortic stenosis; aortic valve; structural valve deterioration; transcatheter aortic valve replacement.