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Clinical Trial
. 2019 May-Jun;51(3-4):270-279.
doi: 10.1080/07853890.2019.1614657. Epub 2019 May 21.

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Timo Mäkikallio  1 , Maina P Jalava  2 , Annastiina Husso  3 , Marko Virtanen  4 , Teemu Laakso  5 , Tuomas Ahvenvaara  6 , Tuomas Tauriainen  6 , Pasi Maaranen  4 , Eeva-Maija Kinnunen  5 , Sebastian Dahlbacka  5 , Jussi Jaakkola  2 , Juhani Airaksinen  2 , Vesa Anttila  2 , Mikko Savontaus  2 , Mika Laine  5 , Tatu Juvonen  5 , Antti Valtola  3 , Peter Raivio  5 , Markku Eskola  4 , Matti Niemelä  1 , Fausto Biancari  2   6   7
Affiliations
Clinical Trial

Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Timo Mäkikallio et al. Ann Med. 2019 May-Jun.

Abstract

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased three-fold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p = .011) and from 4.1% to 1.8% for SAVR (p = .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p = .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 Key Messages This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.

Keywords: Transcatheter aortic valve implantation (TAVI); aortic valve stenosis (AS); surgical aortic valve replacement (SAVR).

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Conflict of interest statement

T.M., none; M.P.J., none; T.L, none; M.V., none; M.N., none; T.A, none; T.T, none; P.M., none; A.H., none; E.M.K., none; S.D. received a grant from the Finnish Society of Angiology; J.J., none; J.A., none; V.A., none; S.R, none; P.D.E, none; M.S., is proctor for Medtronic, relationship is significant; M.L., is proctor for Boston Scientific, relationship is significant; T.M., none; A.V., none; P.R. none; M.E, none; F.B., none.

Figures

Figure 1.
Figure 1.
Study flowchart and annual number of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) along the study period.
Figure 2.
Figure 2.
Frequencies of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) along the study period.
Figure 3.
Figure 3.
Operative risk stratified by the Society of Thoracic Surgeons (STS) score in patients who underwent transcatheter (TAVR) or surgical aortic valve replacement (SAVR) along the study period.
Figure 4.
Figure 4.
Observed and predicted 30-day mortality by the Society of Thoracic Surgeons (STS) score in patients who underwent transcatheter (TAVR) or surgical aortic valve replacement (SAVR) along the study period. P-values are from the linear-by-linear association test.
Figure 5.
Figure 5.
Two years survival in patients who underwent transcatheter (TAVR) or surgical aortic valve replacement (SAVR) from 2018 to 2015. p-Values are from the linear-by-linear association test.
Figure 6.
Figure 6.
Incidence of stroke, moderate-to-severe paravalvular regurgitation, acute kidney injury stage 3 and length of hospital stay after transcatheter (TAVR) and surgical aortic valve replacement (SAVR) along the study period. P-values are from the linear-by-linear association test.
Figure 7.
Figure 7.
Rates of red blood cell (RBC) transfusion and of transfusion of >4 units of RBC and/or operation for excessive bleeding in patients who underwent transcatheter (TAVR) or surgical aortic valve replacement (SAVR). P-values are from the linear-by-linear association test.
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References

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