Key result
Over an 8-year period, performing TAVI in the most recent interval (2015-2016) was associated with a 72% reduction in 30-day mortality compared to the earliest interval (2009-2013).
Why the study?
How have patient characteristics and clinical outcomes of TAVI changed over an 8-year period in a real-world population?
Cohort (n=1,011)
No
How have patient characteristics and clinical outcomes of TAVI changed over an 8-year period in a real-world population?
Over an 8-year period, TAVI has been increasingly performed in lower-risk patients, accompanied by significant improvements in device success, complication rates, and 30-day survival.
Answers are grounded in this paper and cite their sources.
Improved TAVI outcomes track lower-risk selection; leaves open whether gains hold in unselected contemporary cohorts.
AIM: In the evolving field of transcatheter aortic valve implantations (TAVI) we aimed to gain insight into trends in patient and procedural characteristics as well as clinical outcome over an 8‑year period in a real-world TAVI population. METHODS: We performed a single-centre retrospective analysis of 1,011 consecutive patients in a prospectively acquired database. We divided the cohort into tertiles of 337 patients; first interval: January 2009-March 2013, second interval: March 2013-March 2015, third interval: March 2015-October 2016. RESULTS: Over time, a clear shift in patient selection was noticeable towards lower surgical risks including Society of Thoracic Surgeons predicted risk of mortality score and comorbidity. The frequency of transfemoral TAVI increased (from 66.5 to 77.4%, p = 0.0015). Device success improved (from 62.0 to 91.5%, p < 0.0001) as did the frequency of symptomatic relief (≥1 New York Heart Association class difference) (from 73.8 to 87.1%, p = 0.00025). Complication rates decreased, including in-hospital stroke (from 5.0 to 2.1%, p = 0.033) and pacemaker implantations (from 10.1 to 5.9%, p = 0.033). Thirty-day mortality decreased (from 11.0 to 2.4%, p < 0.0001); after adjustment for patient characteristics, a mortality-risk reduction of 72% was observed (adjusted hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.13-0.62). One-year mortality rates decreased (from 23.4 to 11.4%), but this was no longer significant after a landmark point was set at 30 days (mortality from 31 days until 1 year) (adjusted HR: 0.69, 95% CI: 0.41-1.16, p = 0.16). CONCLUSION: A clear shift towards a lower-risk TAVI population and improved clinical outcome was observed over an 8‑year period. Survival after TAVI improved impressively, mainly as a consequence of decreased 30-day mortality.
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Kesteren et al. (2018) conducted a cohort in Severe symptomatic aortic valve stenosis (n=1,011). TAVI in recent interval (2015-2016) vs. TAVI in early interval (2009-2013) was evaluated on 30-day mortality (adjusted HR 0.28, 95% CI 0.13-0.62, p=0.0019). Over an 8-year period, performing TAVI in the most recent interval (2015-2016) was associated with a 72% reduction in 30-day mortality compared to the earliest interval (2009-2013).
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