Long-Term Outcomes of Veteran Patients After Transcatheter Aortic Valve Replacement

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a mainstay treatment for severe aortic stenosis and is increasingly used for veterans, producing excellent short-term outcomes. There is a paucity of long-term outcome data after TAVR in the veteran population. METHODS: We examined consecutive patients who underwent TAVR at a single Veterans Affairs medical center through 2019. Baseline characteristics, echocardiographic and angiographic variables, and clinical outcomes were abstracted. All-cause mortality was the primary outcome of interest. Factors associated with all-cause mortality and cardiac-specific mortality, including the presence of significant non-revascularized coronary artery disease (CAD), were assessed with multivariable regression and competing-risk analyses. RESULTS: The 189 consecutive patients enrolled (mean age, 76.6 ± 8.4 years) had a median Society of Thoracic Surgeons (STS) score of 6.0 (interquartile range [IQR], 4.0-8.5). After a maximum follow-up of 7.5 years, 71 (37.6%) deaths occurred, of which 76% had a cardiac cause. Median overall survival was 3.55 years (95% confidence interval [CI], 3.21-5.30); significant graded differences were observed across STS risk subgroups (P<.001). After multivariable adjustment, CAD was significantly associated with cardiac mortality (hazard ratio [HR], 2.6; 95% CI, 1.3-5.3) and all-cause mortality (HR, 2.2; 95% CI, 1.1-4.3). Other independent variables associated with all-cause mortality included age (P=.01), baseline creatinine (P<.01), and chronic obstructive pulmonary disease (P=.03). Baseline ejection fraction (P=.04), age (P<.01), creatinine (P=.02), and vascular disease (P=.04) were independently associated with cardiac-specific mortality. CONCLUSION: Long-term survival of veterans after TAVR is comparable to that of their non-veteran counterparts. Significant CAD, along with age and select comorbidities, was associated with poorer survival.