Changes in demographics, treatment and outcomes in a consecutive cohort who underwent transcatheter aortic valve implantation between 2005 and 2020

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Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) has matured to the treatment of choice for most patients with aortic stenosis (AS). We sought to identify trends in patient and procedural characteristics, and clinical outcomes in all patients who underwent TAVI between 2005 and 2020. Methods: A single-centre analysis was performed on 1500 consecutive patients who underwent TAVI, divided into three tertiles (T) of 500 patients treated between November 2005 and December 2014 (T1), January 2015 and May 2018 (T2) and June 2018 and April 2020 (T3). Results: Over time, mean age and gender did not change (T1 to T3: 80, 80 and 79 years and 53%, 55% and 52% men, respectively), while the Society of Thoracic Surgeons risk score declined (T1: 4.5% to T3: 2.7%, p < 0.001). Use of general anaesthesia also declined over time (100%, 24% and 1% from T1 to T3) and transfemoral TAVI remained the default approach (87%, 94% and 92%). Median procedure time and contrast volume decreased significantly (186, 114 and 56 min and 120, 100 and 80 ml, respectively). Thirty-day mortality (7%, 4% and 2%), stroke (7%, 3% and 3%), need for a pacemaker (19%, 22% and 8%) and delirium (17%, 12% and 8%) improved significantly, while major bleeding/vascular complications did not change (both approximately 9%, 6% and 6%). One-year survival was 80%, 88% and 92%, respectively. Conclusion: Over our 15 years’ experience, patient age remained unchanged but the patient risk profile became more favourable. Simplification of the TAVI procedure occurred in parallel with major improvement in outcomes and survival. Bleeding/vascular complications and the need for pacemaker implantation remain the Achilles’ heel of TAVI.

Original languageEnglish
Pages (from-to)411-422
Number of pages12
JournalNetherlands Heart Journal
Volume30
Issue number9
Early online date25 Feb 2022
DOIs
Publication statusPublished - Sep 2022

Bibliographical note

Funding Information:
J. Daemen received institutional research support from Abbott Vascular, Boston Scientific, Medtronic, Pie Medical and PulseCath BV, and consultancy and speaker fees from Boston Scientific, ReCor, Pie Medical, Medtronic and PulseCath BV. N.M.D.A. Van Mieghem received research grants and advisory fees from Abbott, Boston Scientific, Edwards, Teleflex, Medtronic, PulseCath BV, Daiichi Sankyo and Abiomed. M.J.A.G. De Ronde-Tillmans, R.M. Nuis, J.A. Goudzwaard, P.A. Cummins, T.W. Hokken, M.P.H. van Wiechen, J.F.W. Ooms, F.U.S. Mattace-Raso, M.J. Lenzen and P.P.T. de Jaegere declare that they have no competing interests.

Publisher Copyright:
© 2022, The Author(s).

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