Abstract 364: Results of a Province-wide Field Evaluation of the Use and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Quebec Compared With the STS/ACC Registry

Abstract

Background: After a review of the evidence, our cardiology evaluation unit recommended to the Quebec Ministry of Health that transcatheter aortic valve implantation (TAVI) should be used in carefully selected patients and that use and outcomes be independently monitored. Herein, we describe the first results of our province-wide field evaluation of patient and procedural characteristics and clinical outcomes and compare them with the STS/ACC TVT registry. Methods: Our trained data abstractors conducted a retrospective review of medical charts of all TAVI cases (n=96) in 6 hospitals during April-July 2013. Variables, outcomes and definitions were chosen to enable valid comparison with other registries in Canada and the USA. The evaluation protocol was created in collaboration with a scientific committee of representative interventionists and surgeons. Results: During the 4-month period, the number of TAVI patients varied from 4 to 37 across the 6 centers. Median age was 83 years (interquartile range [IQR]: 78-86) vs 84 years (IQR: 78-88) in the TVT registry. Half of Quebec TAVI patients were women, as in TVT. Documentation of an evaluation by a surgeon was found for only 58% of patients and the STS predicted risk of operative mortality was documented for only 54%. Of these, the median STS score was 6% (IQR: 4-10) compared to 7% (IQR: 5-11) in TVT where 91% of patients were evaluated by 2 surgeons. The most common vascular access approach in Quebec was transfemoral (70% vs. 64% in TVT); the transapical approach was used less in Quebec than in TVT (16% vs. 29%). While all TAVI in the TVT registry used Edwards SAPIEN XT valves, in Quebec 71% of TAVI used Edwards SAPIEN XT valves, 26% were Medtronic Corevalve and 3% were Portico valves. In-hospital mortality in Quebec was 6.3% (95% CI: 1.3-11.2) compared with 5.5% (95% CI: 5.0-6.1) in TVT. Conversion to surgery (3% vs 1%) and insertion of a new permanent pacemaker (13% vs 7%) were higher in Quebec than in TVT. TAVI patients in Quebec spent less time in intensive care (median 31 hours (IQR: 23-70) vs 46 hours (IQR: 25-77) and in hospital after TAVI (median 5 days (IQR: 3-8) vs 6 (IQR: 4-10). They were also more likely to be discharged home than patients in the TVT registry (80% vs 63%). Conclusions: Preliminary results from a province-wide TAVI registry in Quebec suggest that practice and outcomes are similar to those observed in the TVT registry. Compared with TVT, notable differences in practice were less documentation of surgical evaluation and of STS predicted mortality, less use of the transapical approach and more frequent need for a permanent pacemaker. Some differences may relate to use of a greater variety of valve types in Quebec. In-hospital mortality was similar. These results will be discussed with each TAVI team. Continued monitoring and long-term follow-up in collaboration with clinical experts are essential to promote an optimal quality of care.