Key result
Transcatheter aortic valve implantation (TAVI) was utilized in 68% of severe aortic stenosis patients and was associated with a shorter mean hospitalization (1.8 days) than SAVR (8.6 days).
Why the study?
With both SAVR and TAVI holding Class Ia recommendations for specific subgroups of severe AS in the 2021 European guidelines, real-world practice and Heart Team evaluation in this context needed reporting.
Does TAVI compared to SAVR improve 30-day clinical outcomes and hospitalisation length in patients with severe symptomatic AS?
Cohort (n=672)
Does TAVI compared to SAVR improve 30-day clinical outcomes and hospitalisation length in patients with severe symptomatic AS?
Real-world implementation of the 2021 European guidelines resulted in two-thirds of severe AS patients undergoing TAVI, with excellent 30-day outcomes and shorter hospital stays compared to SAVR.
Real-world adherence to 2021 ESC guidelines via Heart Team yields high treatment compliance and low 30-day mortality; reinforces individualized TAVI selection across risk profiles.
BACKGROUND: Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are Class Ia recommended therapies for specific subgroups of severe aortic stenosis (AS) patients in the latest 2021 European guidelines. AIMS: We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations. METHODS: All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded. RESULTS: The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days). CONCLUSIONS: TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
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Wang et al. (2024) conducted a cohort in severe symptomatic aortic stenosis (n=672). Transcatheter aortic valve implantation (TAVI) vs. Surgical aortic valve replacement (SAVR) was evaluated on 30-day mortality. Transcatheter aortic valve implantation (TAVI) was utilized in 68% of severe aortic stenosis patients and was associated with a shorter mean hospitalization (1.8 days) than SAVR (8.6 days).
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