Review of Te Whatu Ora – Counties Manukau Patients Receiving Transcatheter Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) procedures are increasingly being offered in this community, but little is known of local outcomes. The clinical notes of 100 consecutive patients from Counties Manukau and who received TAVI between January 2018 and March 2022 were retrospectively reviewed. The majority (90%) were European/others, 52% were male, the mean age was 80 years (range 20–95 years), and the predominant diagnosis was aortic stenosis (93%). Present symptoms included dyspnoea (90%), chest pain (25%), and syncope (9%). Pre-existing coronary artery disease was present in 81% of patients. The majority had a transfemoral approach (99%), with an Edwards Sapien 3 valve used in 78% of cases. After the procedure 3% were not on antiplatelets or anticoagulants; 86% reported improved symptoms and 26% had post-procedural aortic regurgitation (mild to moderate). It was identified that 25% had a cardiac admission (some multiple) and 66% had a non-cardiac admission over at least 1 year of follow-up. Pacemakers were implanted in 9% pre-TAVI and 9% post-TAVI, with 8% other significant post-procedural complications identified. In the follow-up period there were 13% deaths with a mean time from TAVI to death of 20 months (6–42 months). Transcatheter aortic valve implantation provided symptomatic benefit to most who received this procedure from the Counties Manukau area. However, it should be noted that TAVI is associated with important clinical complications. Equity issues are apparent and need to be considered.