Key result
A later TAVR implantation date was independently associated with a reduction in all-cause mortality (HR 0.847), reflecting improved procedural safety and fewer complications over a 12-year period.
Why the study?
Because the TAVR population and patient outcomes have dramatically changed over the last decade, updated data regarding contemporary practice and temporal trends are needed.
Does later transcatheter aortic valve replacement (TAVR) implantation date improve clinical outcomes and reduce complications in patients with symptomatic severe aortic stenosis?
Observational (n=1,988)
No
Does later transcatheter aortic valve replacement (TAVR) implantation date improve clinical outcomes and reduce complications in patients with symptomatic severe aortic stenosis?
Hazard Ratio: 0.847 (95% CI 0.76–0.94)
p-value: p=0.002
Over a 12-year period, TAVR has become significantly safer and more effective, with shifts toward treating younger, lower-risk patients and marked reductions in complications, hospital length of stay, and mortality.
Later TAVR implantation was associated with lower mortality; extends temporal trends but leaves open whether gains persist across risk strata.
Transcatheter aortic valve replacement (TAVR) has become the mainstay of treatment for patients with severe AS. Since the TAVR population and patients’ outcomes have dramatically changed over the last decade, updated data regarding contemporary practice and trends are pertinent to clinical use. We performed a retrospective observational analysis of consecutive patient who underwent TAVR for symptomatic severe AS between the years 2009 and 2021 in a single high-volume center. Patients were divided into four equal time groups based on the procedure date (2009−2012, 2013−2015, 2016−2018 and 2019−2021). A total of 1988 patients were included in this study and divided into four groups, with 321, 482, 565 and 620 patients in groups 1−4, respectively. Significant trends were seen in baseline characteristics of a few parameters, including lower age, lower procedural risk and reduced rates of comorbidity (p for trend < 0.0001 for all factors mentioned above). A shift was seen in the procedural technique with lower balloon pre-dilatation and higher device success rates (p for trend < 0.0001). The post-procedural period changed over the years with fewer pacemaker placements (p < 0.0001) and reduced rates of AKI and post-procedural bleed (p value 0.02 and <0.0001, respectively). Furthermore, overall hospital stay was shortened from 7 ± 7.1 days to 2.3 ± 1.7 (p < 0.0001). Finally, patient follow up revealed reduced mortality rates at 30 days (p < 0.0001) and 1 year (p = 0.013). Multivariate regression revealed that a late implantation date was an independent protector from mortality (HR 0.84, p = 0.002). In conclusion, our study demonstrated that TAVR has become a safer practice over the years with reduced rates of morbidity and mortality.
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Frydman et al. (2022) conducted an observational in Symptomatic severe aortic stenosis (n=1,988). Later TAVR implantation date (temporal trend) vs. Earlier TAVR implantation date was evaluated on All-cause mortality (per later time group) (HR 0.847, 95% CI 0.76-0.94, p=0.002). A later TAVR implantation date was independently associated with a reduction in all-cause mortality (HR 0.847), reflecting improved procedural safety and fewer complications over a 12-year period.
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