Outcomes in the South African SHARE-TAVI registry: comparison of mortality and risk between treated and untreated cohort, and recent 1-year outcomes in the maturing local TAVR programme

Abstract

Abstract The South African SHARE TAVI Registry collects local TAVI data to inform health policy, promote access to healthcare, and benchmark the local TAVI programme against recognised best practice. Strong Funder resistance still hampers treatment of aortic stenosis patients after >10 years of TAVI in SA. Method A web-based voluntary all-comers prospective registry captured 2083 patients' clinical history, demographics, TAVI outcomes, complications (VARC 2 definitions) and follow up at 30d, annually post TAVI (8 years). 462 patients assessed for TAVI but not implanted(49 exited prior to funding application, 413 during or after process) were also captured and followed up to 1-year, 413 of these exited during/after the funding application process, 49 exited prior to process (patient declined/unsuitable anatomy). Results Patient populations are similar to other registries and studies using similar generation devices (Schaafsma et al 2022). Outcomes at 30d, 1, 2, and 5 years are comparable to other early TAVI programmes (GARY, Corevalve, PARTNER 1). Average days to Mortality of 813/2545 full patient cohort calculated from date of TAVI Assessment & TAVI procedure date if applicable was highest in implanted patients (693d & 612d) , and lowest in those exiting the programme with no changes to treatment (216d). Most common exit reason was declined funding (71 pts) or death in the funding application process (105pts). Mortality in 68 pts waiting for a response averaged at 93d with STS of 10.996%, and 37 pts with approved funding demised prior to the TAVI date at average 78d in funding process with STS of 9.7%. NON-TAVI patients (n=49) referred for medical or surgical treatment had a longer life expectancy (475 & 366d) than patients who immediately declined implants after the assessment (182d with STS score 7.943). 1year mortality in the 2021 cohort is 14.1%, and in 2022 cohort procedural success is 99.3%, mortality at 30d is 2.53%. Conclusion SA's TAVI programme provides clear benefit to Aortic stenosis patients in terms of life expectancy and the maturing programme's high procedural success and extended life expectancy as shown in local data may be used to support access to treatment in the face of funding resistance.Table 1