Temporal trends in adoption and outcomes of transcatheter aortic valve implantation: a SwissTAVI Registry analysis

Author:

Stortecky Stefan1,Franzone Anna1,Heg Dik2,Tueller David3,Noble Stephane4,Pilgrim Thomas1,Jeger Raban5,Toggweiler Stefan6,Ferrari Enrico7,Nietlispach Fabian8,Taramasso Maurizio8,Maisano Francesco8,Grünenfelder Jürg9,Muller Olivier10,Huber Christoph4,Roffi Marco4,Carrel Thierry1,Wenaweser Peter9,Windecker Stephan1

Affiliation:

1. Department of Cardiology and Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

2. Department of Clinical Research, Clinical Trials Unit and Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland

3. Department of Cardiology, Triemli Hospital Zurich, Zurich, Switzerland

4. Division of Cardiology and Cardiovascular Surgery, University Hospital Geneva, Geneva, Switzerland

5. Department of Cardiology, Basel University Hospital, University of Basel, Basel, Switzerland

6. Department of Cardiology, Cantonal Hospital Lucerne, Lucerne, Switzerland

7. Department of Cardiovascular Surgery, Cardiocentro Ticino, Lugano, Switzerland

8. Department of Cardiology and Department of Cardiovascular Surgery, University Heart Centre Zurich, University Hospital Zurich, Zurich, Switzerland

9. Department of Cardiology and Cardiovascular Surgery, Heart Clinic Hirslanden, Hirslanden Clinic Zurich, Zurich, Switzerland

10. Department of Cardiology, Lausanne University Hospital—CHUV, Lausanne, Switzerland

Abstract

Abstract Aims To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years. Methods and results Between 2011 and 2015, a total of 3493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analysed for the purpose of this study. The primary outcome measure was all-cause mortality at 1 year after TAVI. Over the 5-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, P < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8%, and 15.9% in 2011, 2012, and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation, and Stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted at 30-day follow-up during the latest compared with earlier years of recruitment. Conclusion This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients’ baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.

Funder

Swiss Heart Foundation

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Health Policy

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