Contemporary Life Expectancy Following Transfemoral Transcatheter Aortic Valve Replacement-Data From a National...

The estimated lifespan following transcatheter aortic valve replacement (TAVR) is the key in the decision-making process of lifelong management of patients with severe symptomatic aortic stenosis (AS). We aimed to assess the contemporary lifespan and associated factors in patients with severe AS undergoing TAVR.

We performed a retrospective cohort study of patients who underwent TAVR at the 4 largest centers in Israel between July 2008 and March 2023. Mortality predictors were assessed using multivariable Cox regression analysis.

The cohort included 6191 patients (51% females; mean age 82.7 ​± ​5.4 years; median follow-up 5.9 years). The overall estimated 5- and 10-year survival was 70 and 42%, respectively. To assess temporal trends, patients were stratified to early (2008-2015; n ​= ​2058) and late (2016-2023; n ​= ​4133) eras. Patients in the early TAVR era had significantly lower survival probability, compared to the late era (hazard ratio 2.0 (95% confidence interval 1.8-2.2), p ​< ​0.001], with an 8-year survival of 39 and 71%, respectively. Using an age threshold of ≥80 years, defined using spline analysis the 8-year survival in the early vs. late eras was 37 vs. 47% among older patients and 66 vs. 82% among younger patients.

Lifespan following successful TAVR has markedly improved over the past decade across age groups. Notably, patients younger than 80 years, at the time of TAVR exhibit an estimated survival exceeding 10 ​years. These findings should be integrated into Heart Team decision-making for optimal lifelong management of AS.