Key result
Contemporary TAVI is linked to ~53% lower 1-year mortality compared to the early era.
Why the study?
To evaluate contemporary trends and outcomes of TAVI over an 8-year period in a high-volume center.
Does contemporary TAVI practice (2017-2019) improve mortality outcomes compared to early practice (2012-2016) in adult patients with severe aortic stenosis?
Cohort (n=1,485)
Yes
Does contemporary TAVI practice (2017-2019) improve mortality outcomes compared to early practice (2012-2016) in adult patients with severe aortic stenosis?
Absolute Event Rate: 3.2% vs 6.8%
p-value: p=<0.001
Contemporary TAVI practice is associated with significantly lower early and 1-year mortality compared to earlier experience, despite being performed in older and higher-risk patients.
Supports expanding TAVI to higher-risk patients; leaves open whether advances or selection explain the association.
Introduction Since the first transcatheter aortic valve implantation (TAVI), remarkable changes in procedure features and patients' profile have been reported, making it a widespread treatment for severe aortic stenosis in all risk-class patients. Purpose To evaluate TAVI contemporary trends and outcomes in the last 8 years in a high-volume TAVI center. Methods Data of adult patients submitted to TAVI from April 2012 to April 2019 in a high-volume center were obtained from the Swiss TAVI registry, a prospective national multi-center database. Patients were divided according to implant period in two groups: 1) TAVI performed from 2012 to 2016, and 2) TAVI performed from 2017 to 2019. Results Over a 8-years period, a total of 1485 procedures were performed, increasing from 95 in 2012 to 320 in 2018 (p<0.001). A remarkable modification in patients' profile and procedure characteristics can be seen in Table 1. Despite higher age and surgical risk, a significant decrease in 1-year mortality (6.8% vs. 3.2%; p<0.001) was observed in the last 3 years. This difference was especially notable in the subgroup of high-risk patients (STS score ≥8), who presented a decrease in 30-days (5% vs. 3.3%; p=0.001) and 1-year mortality (13.1% vs. 4.9%; p<0.001). In multivariate analysis, age (OR 1.05, 95% CI: 1.0–1.1), non-femoral access (OR 2.7, 95% CI: 1.2–6.0), and STS score (OR 1.07, 95% CI: 1.0–1.1) were independent predictors of in-hospital mortality, while male gender (OR 1.8, 95% CI: 1.0–3.2), chronic obstructive pulmonary disease (OR 2.1, 95% CI: 1.1–3.9), and STS score (OR 1.07, 95% CI: 1.01–1.14) were predictors of 1-year mortality. Conclusion Significant changes in patients' profile and procedure characteristics were observed in the last 3 years of TAVI experience. Even performed in elderly and high-risk patients, TAVI was associated with low early and 1-year mortality. The Swiss TAVI registry offers a unique opportunity to monitor trends and outcomes in patient submitted to TAVI. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): APT is a Ph.D. study and her scientific research is supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Capes) - Finance Code 001.
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Tagliari et al. (2020) conducted a cohort in Severe aortic stenosis (n=1,485). TAVI performed from 2017 to 2019 vs. TAVI performed from 2012 to 2016 was evaluated on 1-year mortality (p=<0.001). TAVI performed between 2017 and 2019 was associated with significantly lower 1-year mortality compared to the 2012-2016 period (3.2% vs. 6.8%; P<0.001).
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