OUTCOMES FOLLOWING TRANSCATHETER AORTIC VALVE IMPLANTATION (TAVI) IN ONTARIO (2007-2013)

Abstract

The Cardiac Care Network of Ontario (CCN) works to plan, coordinate, implement and evaluate adult cardiovascular care in Ontario, and is responsible for maintaining the CCN Cardiac Registry. Transcatheter Aortic Valve Implantation (TAVI) is a transcatheter procedure to replace diseased aortic valves, without the need for open heart surgery. Ten (10) hospitals in Ontario provide TAVI procedures. All 10 hospitals enter data in the CCN Cardiac Registry. All TAVI procedures in the CCN Cardiac Registry between January 2007 and November 2013 were analyzed. Patient characteristics and procedural details were obtained from the CCN Cardiac Registry. Data from the CCN Cardiac Registry was linked to the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) and the Ontario Registered Persons Database (RPDB) to calculate post-procedural outcomes. The primary outcomes measured were crude unadjusted all-cause mortality and readmission rates and were calculated at varying time points, out to 3-years post-procedure. A secondary analysis was performed focusing on outcomes for more recent TAVI procedures (January 2010 to November 2013). This study was developed by CCN, with data analysis completed by the Institute for Clinical Evaluative Sciences. A total of 1,105 unique TAVI procedures were identified and linked to the CIHI-DAD and RPDB. Analysis of TAVI procedures in Ontario revealed that the majority of procedures performed were done via femoral access (73.7%). In-hospital mortality was found to be 6.2% overall with rates being lower for transfemoral procedures (4.2%) versus non-transfemoral (11.7%). At 1-year post-procedure the overall all-cause mortality rate was 19.4% with an all-cause readmission rate of 49.3%. At 3-years post-procedure, the overall all-cause mortality rate was 43.9% with an all-cause readmission rate of 74.7%. Overall, mortality rates in Ontario following TAVI procedures are comparable to rates reported by other jurisdictions. Although all-cause mortality and readmission rates at 3-years are high, this may be explained by comorbidities and frailty in the TAVI patient population, as well as the fact this registry covers the early experience for most centres. In general we believe based on these outcomes that TAVI is a relatively safe and effective procedure to treat aortic stenosis in patients who are at extreme or high risk for conventional cardiac surgery in Ontario. CCN will continue to report on outcomes following TAVI procedures in Ontario to ensure that all Ontarians have access to the highest possible quality of cardiac care.