Outcomes of First 300 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 with steady increase in the number of implanting centres from 7 in 2008 to 46 in 2018 (26 private and 20 public hospitals). There is limited published data on outcomes from Australian centres and no published data from Australian private hospitals. We describe outcomes of the first 300 cases at Australia's first TAVI implanting private hospital. From July 2015- August 2018, 300 patients with severe, symptomatic aortic stenosis underwent TAVI at our centre. A Heart-team assessed all patients as suitable. All patients underwent computed tomography (CT) assessment of valve sizing and peripheral access. Mean age was 85 years, 58% male, mean STS score 4.0%, 49% had NYHA Class III/IV, 28% previous CABG, 14% peripheral vascular disease and 3.7% renal impairment (Cr >177 μmol/L). At 30 days mortality was 1%, stroke 1.4%, myocardial infarction (MI) 0.3%, major vascular complication 3.1%, no life-threatening or disabling bleeding and new permanent pacemaker (PPM) requirement was 9.2%. Paravalvular leak was none, trace and mild in 27%, 53% and 20% respectively with no ≥ moderate paravalvular leak. At 1year, mortality was 6%, stroke 2.6%, MI 0.3%, no life-threatening bleeding and PPM 12.2%. Lower rates of mortality, stroke, MI, major vascular complications and major bleeding were observed compared to the landmark PARTNER 2A trial. 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.