903 Transcatheter Aortic Valve Implantation in New Zealand: The First Decade

Abstract

Transcatheter aortic valve implantation (TAVI) is a well-established therapy for aortic stenosis, the most common acquired valvular heart disease in New Zealand (NZ). In this study, we reviewed the demographics, geographic distribution and survival rates of patients undergoing TAVI. Patients undergoing TAVI in a NZ hospital from 2008 to 2018 were collected via the National Minimum Dataset and ICD-10 procedure codes. National and District Health Board (DHB) TAVI rates were age-standardized using census data. Mortality data were analyzed using standard statistical methods. From 2008 to 2018, 952 patients underwent TAVI in NZ (42.5% women, mean age 80.0±7.5 years, 93.5% European). TAVI commenced at 5 hospitals at varying time point; Waikato 2008, Auckland City 2011, Christchurch 2011, Dunedin 2015 and Wellington 2017. From 2013 to 2018, the national age-standardized TAVI rate increased from 1.5 to 4.9 per 100,000 people. In 2018, TAVI rates ranged from 2.0 to 12.8 per 100,000 people in Hutt Valley and South Canterbury DHB respectively. There was also a significant ethnic difference in TAVI rates (European 6.6, Pacific 0.8, Maori 0.5 per 100,000 people). The national one-year survival was 93.5%, with no difference between hospitals. European, Pacific and Maori patients’ one-year survival were 93.9%, 88.2%, and 80.1% respectively. Despite Maori patients being significantly younger than Europeans (67.9 vs 80.6 years, p<0.05), they were less likely to survive at one-year independent of age (19.2% vs 6.1%, HR4.2, 95% CI:1.6-11.5, p=0.004). There are significant geographical and ethnic variations in TAVI rates in NZ. Maori had worse one-year survival than European patients following TAVI.