Key result
Over 15 years of TAVI experience, procedural simplification and a more favorable patient risk profile were associated with a significant reduction in 30-day mortality from 7% in the earliest cohort to 2% in the most recent cohort.
Why the study?
As TAVI has matured into the treatment of choice for most patients with AS, trends in patient characteristics, procedural factors, and clinical outcomes over time needed characterization.
Does the evolution of TAVI practice over 15 years improve clinical outcomes in patients with aortic stenosis?
Cohort (n=1,500)
No
Does the evolution of TAVI practice over 15 years improve clinical outcomes in patients with aortic stenosis?
Absolute Event Rate: 2% vs 7%
p-value: p=0.001
Over 15 years, TAVI procedures have become simpler and safer with improved survival, though bleeding, vascular complications, and pacemaker requirements remain significant challenges.
TAVI survival improved over 15 years amid shifting patient profiles; leaves open generalizability and drivers of change.
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has matured to the treatment of choice for most patients with aortic stenosis (AS). We sought to identify trends in patient and procedural characteristics, and clinical outcomes in all patients who underwent TAVI between 2005 and 2020. METHODS: A single-centre analysis was performed on 1500 consecutive patients who underwent TAVI, divided into three tertiles (T) of 500 patients treated between November 2005 and December 2014 (T1), January 2015 and May 2018 (T2) and June 2018 and April 2020 (T3). RESULTS: Over time, mean age and gender did not change (T1 to T3: 80, 80 and 79 years and 53%, 55% and 52% men, respectively), while the Society of Thoracic Surgeons risk score declined (T1: 4.5% to T3: 2.7%, p < 0.001). Use of general anaesthesia also declined over time (100%, 24% and 1% from T1 to T3) and transfemoral TAVI remained the default approach (87%, 94% and 92%). Median procedure time and contrast volume decreased significantly (186, 114 and 56 min and 120, 100 and 80 ml, respectively). Thirty-day mortality (7%, 4% and 2%), stroke (7%, 3% and 3%), need for a pacemaker (19%, 22% and 8%) and delirium (17%, 12% and 8%) improved significantly, while major bleeding/vascular complications did not change (both approximately 9%, 6% and 6%). One-year survival was 80%, 88% and 92%, respectively. CONCLUSION: Over our 15 years' experience, patient age remained unchanged but the patient risk profile became more favourable. Simplification of the TAVI procedure occurred in parallel with major improvement in outcomes and survival. Bleeding/vascular complications and the need for pacemaker implantation remain the Achilles' heel of TAVI.
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Ronde-Tillmans et al. (2022) conducted a cohort in Aortic stenosis (n=1,500). Transcatheter aortic valve implantation (TAVI) in recent era (2018-2020) vs. TAVI in early era (2005-2014) was evaluated on 30-day mortality (p=0.001). Over 15 years of TAVI experience, procedural simplification and a more favorable patient risk profile were associated with a significant reduction in 30-day mortality from 7% in the earliest cohort to 2% in the most recent cohort.
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