Abstract
Background: TAVI has become an accepted technique for high-risk patients with severe, symptomatic aortic stenosis (AS). Whilst there are many TAVI programs in public institutions in Australia, due to current funding limitations private hospital TAVI programs remain scarce. We aimed to compare the short-term outcomes between two well established public and private TAVI programs; The Alfred Hospital and Epworth Hospital in Melbourne, Australia. Methods: We describe a prospective observational cohort of 500 patients who underwent TAVI in these hospitals between 2008 and 2016. The same procedural teams operate at both sites. Risk-stratified case selection for TAVI is performed by multidisciplinary Heart Teams at both sites designed to comply with the CSANZ TAVI position statement. Procedural data are stored in a shared TAVI database according to VARC-2 definitions. Results: Over the study period 265 (53%) patients underwent TAVI in the public hospital and 235 (47%) patients in the private hospital. Public patients were slightly younger, median age 84 years (IQR 80,87) vs. median age 85 years (IQR 82,88), p < 0.01. STS scores was similar (4 [IQR 3,6] vs. 4.3 [3,7], p = 0.35). Self-expanding valves were used more frequently overall in both sites (74% vs. 98% p < 0.01), with more balloon expandable valves in public (26% vs. 2%, p < 0.01). All-cause 30-day mortality was very low at both sites (1.9% vs. 0.9%, p = 0.32). Rates of permanent pacemaker (23% vs. 28%, p = 0.26) and length-of-stay (4 [IQR3,7] vs. 5 [IQR 4-7], p = 0.06 days, were also similar. Conclusions: Despite the current funding limitations for TAVI in Australia, comprehensive TAVI programs with excellent clinical outcomes for patients are achievable at both public and private hospitals.
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