Ten-year Trends in Transcatheter Aortic Valve Implantation

Abstract

Background: One of the first transcatheter aortic valve implantations (TAVI) in Australia was performed in Victoria in 2008. Since then, this program has performed over 800 TAVIs. We aimed to determine temporal changes in patient and procedural characteristics and clinical outcomes over ten years. Methods: Between 2008 and 2017, all patients who underwent TAVI in two experienced centres in Melbourne were followed-up for 1 year. Outcomes were analysed based on the Valve Academic Research Consortium (VARC)-2 criteria. Results: The number of TAVIs performed significantly increased each year from 11 in 2008 to 136 in 2017 (p < 0.01). Initially, most patients had an STS-PROM score of ≥4 (2008: 63.7%), compared with contemporary patients who have an STS-PROM score <4 (2017: 59.3%) (p < 0.01). Contemporary patients are treated earlier in the disease process with a mean pressure gradient (mmHg) of 51.0 ± 14.9 in 2008 to 46.3 ± 14.6 in 2017 (p < 0.01). Coinciding with an increasing use of third generation devices, there has been a decline in conduction abnormalities requiring permanent pacemaker implantation (PPM, 2008: 55.6% to 2017: 22.8%, p < 0.001). Progressively, more patients are discharged ≤5 days (2017: 66.2% vs. 2008: 9.1%, p < 0.01). Periprocedural and 1-year mortality remain low and unchanged (p = 0.24 and p = 0.22, respectively), as were other VARC-2 outcomes (p = NS). Conclusion: There has been a significant change in the patient population undergoing TAVI, with patients at lower risk and undergoing TAVI earlier in the disease process. PPM implantation and length of stay have declined significantly. Other VARC-2 outcomes remained unchanged at a low rate.