520 Outcomes of 1098 Transcatheter Aortic Valve Implantation: A Statewide Population-Linkage Study

Abstract

The increasing implementation of transcatheter aortic valve implantation (TAVI) in Australia warrants real-world data on the prevalence and outcomes of these patients. From the Centre-of-Health-Record-Linkage registry, all New South Wales (NSW) residents who underwent TAVI between 5-June,2013 to 30-June2018 were identified. The registry holds population-linked records of residents admitted to >97% of healthcare facilities in NSW, the largest Australian state. Cause-specific mortality were tracked from the statewide death registry. The study cohort comprised 1098 persons (mean[±SD] age: 83.3±7.7yrs; 58.8% males). Case-volumes rose from 30 in 2013 to 345 by 2017 (>40% increase per-annum). 11.4% required permanent pacemaker insertion during the TAVI admission. Heart failure (14.3%), myocardial infarction (MI) (14.3%), and sepsis (14.3%) were the primary causes of in-hospital death. Post-discharge, sepsis (25.2%) was the most common cause of death, while heart failure and MI accounted for 16.6% and 7.6% respectively. Prior heart failure, chronic kidney disease, and requirement for mechanical ventilation were all independent predictors of death in-hospital and at 180-days follow-up. The number of patients undergoing TAVI increased 10-fold between 2013 and 2017. Mortality rates are comparable to international cohorts at short and medium-term follow-up. Identifying predictors of mortality may help optimise the application of this procedure.Tabled 1All-cause deathTotal (n=1,098)Male (n=646)Female (n=452)P-valueIn-hospital1.3%1.2%1.3%0.9030-days2.0%1.5%2.7%0.20180-days4.9%5.0%4.9%0.95Total death20.4%20.3%20.6%0.90Mean follow-up, months21.8±13.920.7±13.323.3±14.7 Open table in a new tab