TAVI is increasingly used but few data exist on long-term outcome.

We analyzed 7-year outcome after TAVI and its predictive factors.

Between 2006 and 2011, 289 consecutive high-risk patients (EuroScore 23±14%) 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 pts (92%). At 30 days, 34 patients died (congestive heart failure in 14, peri-procedural death in 10 and septic shock in 10). We focused on the 255 patients discharged alive after TAVI to analyze long-term outcome. Follow-up was complete in 100% of patients. During a mean follow-up of 4.1±0.2 years, 139 patients died, half of deaths being non-cardiac.

Overall 7-year survival rate was 26±9%. We identified 5 preprocedural predictive factors of late mortality in multivariate analysis: cancer (p=0.001), diabetes under insulin therapy (p=0.02), NYHA class III-IV (p=0.03), atrial fibrillation (p=0.04), higher creatinin level (p<0.0001) and 2 post-procedural factors: higher systolic PAP (p=0.02) and arrhythmias (p=0.02). 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 116 survivors, 70% were in NYHA class I-II at last follow-up.

At 7-year follow-up after TAVI, the survival rate was 27% and most patients have 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.