Does transcatheter aortic valve implantation (TAVI) performed in later years improve 1-year mortality compared to earlier years in a Swiss national registry?
Over a 5-year period in Switzerland, TAVI adoption increased six-fold and 1-year mortality significantly decreased, driven in part by a progressive reduction in patients' baseline surgical risk.
Abstract Aims To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years. Methods and results Between 2011 and 2015, a total of 3493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analysed for the purpose of this study. The primary outcome measure was all-cause mortality at 1 year after TAVI. Over the 5-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, P < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8%, and 15.9% in 2011, 2012, and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation, and Stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted at 30-day follow-up during the latest compared with earlier years of recruitment. Conclusion This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients’ baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.
Stortecky et al. (Mon,) studied this question.