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Temporal Trends in Adoption and Outcomes of Transcatheter Aortic Valve Implantation: A Swisstavi Registry Analysis


Stortecky, Stefan; Franzone, Anna; Heg, Dik; Tueller, David; Noble, Stephane; Pilgrim, Thomas; Jeger, Raban; Toggweiler, Stefan; Ferrari, Enrico; Nietlispach, Fabian; Taramasso, Maurizio; Maisano, Francesco; Grünenfelder, Jürg; Muller, Olivier; Huber, Christoph; Roffi, Marco; Carrel, Thierry; Wenaweser, Peter; Windecker, Stephan (2018). Temporal Trends in Adoption and Outcomes of Transcatheter Aortic Valve Implantation: A Swisstavi Registry Analysis. European Heart Journal - Quality of Care and Clinical Outcomes:Epub ahead of print.

Abstract

Aims To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years. Methods and Results Between 2011 and 2015, a total of 3'493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analyzed for the purpose of this study. The primary outcome measure was all-cause mortality at 1-year after TAVI. Over the five-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, p < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8% and 15.9% in 2011, 2012 and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015, with a significant temporal trend. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation and stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted during the latest compared with earlier years of recruitment. Conclusions This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients' baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.

Abstract

Aims To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years. Methods and Results Between 2011 and 2015, a total of 3'493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analyzed for the purpose of this study. The primary outcome measure was all-cause mortality at 1-year after TAVI. Over the five-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, p < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8% and 15.9% in 2011, 2012 and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015, with a significant temporal trend. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation and stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted during the latest compared with earlier years of recruitment. Conclusions This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients' baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.

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Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:aortic Stenosis transcatheter aortic valve Implantation mortality, trends
Language:English
Date:9 October 2018
Deposited On:25 Oct 2018 11:50
Last Modified:25 Oct 2018 12:01
Publisher:Oxford University Press
ISSN:2058-1742
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/ehjqcco/qcy048
PubMed ID:30304513

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