Long-Term Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Elderly Patients: A 5-Year Multicenter Analysis
Abstract
Background
Transcatheter aortic valve replacement (TAVR) has emerged as the preferred modality for patients with severe aortic stenosis deemed inoperable or high surgical risk. However, long-term data in the Indian elderly population remains sparse. This study evaluates 5-year clinical outcomes of TAVR performed at tertiary cardiac centers across India.
Methods
A retrospective multicenter cohort study was conducted across 6 tertiary cardiac centers between 2018–2023. A total of 412 patients aged ≥75 years with severe aortic stenosis and STS score ≥8% were included. Primary endpoints were all-cause mortality, stroke, and repeat hospitalization at 1, 3, and 5 years. Secondary endpoints included valve hemodynamic performance assessed by echocardiography.
Results
5-year all-cause mortality was 28.6% (n=118). Stroke incidence was 4.1% at 1 year and 9.7% at 5 years. Significant paravalvular leak (≥moderate) was observed in 6.3% of patients. Mean aortic valve gradient remained stable at 11.2 ± 3.8 mmHg at 5-year follow-up. Multivariate analysis identified frailty index and pre-procedural atrial fibrillation as independent predictors of long-term mortality.
Conclusion
TAVR demonstrates durable hemodynamic performance and acceptable long-term survival in high-risk elderly Indian patients. Frailty assessment and pre-procedural rhythm optimization are critical to improving outcomes. These findings support broader adoption of TAVR in tier-1 and tier-2 cardiac centers.
Conflict of Interest
No conflicts of interest declared. No external funding received.