Long-term survival after transcatheter aortic valve implantation in the modern era compared with the general population - a Nationwide Danish Cohort Study.

Objective: Recent advancements in transcatheter aortic valve implantation (TAVI) and patient selection have significantly improved the outcomes of TAVI. Yet it is unknown whether patients undergoing TAVI in the modern era have comparable mortality as the general population.

Methods: All patients undergoing TAVI in Denmark (2015-2023) were matched on age and sex with controls from the general population (1:4). Patients were followed from 30-days post-TAVI until death or end of study (12/23). The 5-year all-cause mortality was examined by cumulative incidence functions and Cox-regression analyses. The 5-year all-cause hospitalization burden was analysed among those alive at 5-year post-index.

Results: The study included 7,250 patients undergoing TAVI (median age 81.2 years (IQR 77.0-84.9), 57.3% men) and 29,000 controls. The absolute risk of death was 39.6% (95%CI 38.1-41.2) in the TAVI group, compared to 32.2% (95%CI 31.5-32.9) among controls. The associated all-cause mortality was similar between patients undergoing TAVI and controls (adjusted HR 0.95 [95%CI 0.90-1.01]). Stratification by age revealed a higher risk of death among the TAVI group aged <80 years compared to controls, while patients aged ≥80 years showed a lower risk of death. Patients undergoing TAVI experienced longer and more frequent hospitalizations compared to controls, while the relative difference decreased over time.

Conclusion: Our findings suggest that TAVI was associated with long-term mortality and hospitalization rates comparable to the general population. Stratified by age, mortality was higher among TAVI patients <80 years and lower among those ≥80 years. These findings support patient selection, safety, and long-term outcomes of TAVI.