860 Outcomes of First 500 Cases of Transcatheter Aortic Valve Implantation at a High-Volume Australian Private Hospital

Abstract

Transcatheter aortic valve implantation (TAVI) was first performed in Australia in 2008 and grown to 42 implanting centres nationwide. There is limited published data on outcomes from Australian centres, especially private hospitals. We describe outcomes of the first 500 cases at Queensland’s first TAVI implanting private hospital. From July 2015-March 2020, 500 patients with severe, symptomatic aortic stenosis underwent TAVI at our centre. A multidisciplinary heart-team assessed all patients as suitable. Computed tomography (CT) TAVI assessment was mandatory for procedural planning. Mean age was 85 years old, 57% were male, mean STS score 4.0%, 49% had NYHA Class III/IV, 24% previous CABG, 14% peripheral vascular disease and 4.7% renal impairment. At 30 days mortality was 1.2%, stroke 1.0%, myocardial infarction (MI) 0.2%, major vascular complication 2.5% and new permanent pacemaker (PPM) requirement was 8.4%. Post-procedural paravalvular leak was none or trace in 82.7% mild in 16.8% and ≥moderate in 0.4%. At 1year, mortality was 4.3%, stroke 1.4%, no life-threatening bleeding and PPM 10.1%. Between patients 1-300, 301-400, and 401-500, we observed improvements in major adverse cardiac/cerebrovascular events (4.8%, 4.6%, 2.0%) and post-procedural paravalvular leak of none/trace (80%, 81%, 89%) respectively. Excellent TAVI clinical outcomes can be achieved in the Australian private hospital setting. Expert Heart Team assessment and CT guided procedural planning are key to these outcomes. Cumulative volume experience appears linked to achieving sustained excellent results.