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

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.

Keywords: Aortic stenosis; Mortality; Transcatheter aortic valve implantation; Trends.