Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 25;13(17):5027.
doi: 10.3390/jcm13175027.

Temporal Trends in Patient Characteristics and Clinical Outcomes of TAVR: Over a Decade of Practice

Nour Karra  1 , Amir Sharon  1 , Eias Massalha  1   2 , Paul Fefer  1   2 , Elad Maor  1   2 , Victor Guetta  1   2 , Sagit Ben-Zekry  1   2 , Rafael Kuperstein  1   2 , Shlomi Matetzky  1   2 , Roy Beigel  1   2 , Amit Segev  1   2 , Israel M Barbash  1   2
Affiliations

Temporal Trends in Patient Characteristics and Clinical Outcomes of TAVR: Over a Decade of Practice

Nour Karra et al. J Clin Med. .

Abstract

Background/Objective: Transcatheter aortic valve replacement (TAVR) is indicated for severe aortic stenosis patients with a prohibitive surgical risk. However, its use has been expanding in recent years to include intermediate- and low-risk patients. Thus, registry data describing changes in patient characteristics and outcomes are needed. The aim of this study was to analyse the temporal changes in patient profiles and clinical outcomes of all-comer TAVR. Methods: Baseline characteristics and VARC-3 outcomes of 1632 consecutive patients undergoing TAVR between 2008 and 2021 were analysed. Results: The annual rate of TAVR increased from 30 procedures in 2008-2009 to 398 in 2020-2021. Over the follow-up period, patient age decreased from 85 ± 4 to 80 ± 6.8 (p < 0.001) and the STS score decreased from 5.9% to 2.8% (p < 0.001). Procedural characteristics significantly changed, representing a shift into a minimally invasive approach: adoption of local anaesthesia (none to 48%, p < 0.001) and preference of transfemoral access (74% in 2011-2012 vs. 94.5% in 2020-2021, p < 0.001). The rates of almost all procedural complications decreased, including major vascular and bleeding complications, acute kidney injury (AKI) and in-hospital heart failure. There was a striking decline in rates of complete atrioventricular block (CAVB) and the need for a permanent pacemaker (PPM). PPM rates, however, remain high (17.8%). Thirty-day and one-year mortality significantly declined to 1.8% and 8.3%, respectively. Multivariable analysis shows that AKI, bleeding and stroke are strong predictors of one-year mortality (p < 0.001). Conclusions: The TAVR procedure has changed dramatically during the last 14 years in terms of patient characteristics, procedural aspects and device maturity. These shifts have led to improved procedural safety, contributing to improved short- and long-term patient outcomes.

Keywords: TAVR; aortic stenosis; low risk; temporal trends.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
TAVR complication rates per year. Results are expressed as frequencies (N) and percentages (%) of yearly procedures. The χ2 test was used to compare percentages of categorical variables. p < 0.05 was considered significant.
Figure 2
Figure 2
(A) Unadjusted cumulative probability of death over a one-year follow-up (p < 0.05) (B) Cumulative probability of death over one year adjusted for STS score, stage 2–3 AKI, major bleeding and stroke.
See this image and copyright information in PMC

References

    1. Leon M.B., Smith C.R., Mack M., Miller D.C., Moses J.W., Svensson L.G., Tuzcu E.M., Webb J.G., Fontana G.P., Makkar R.R., et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010;363:1597–1607. doi: 10.1056/NEJMoa1008232. - DOI - PubMed
    1. Deeb G.M., Reardon M.J., Chetcuti S., Patel H.J., Grossman P.M., Yakubov S.J., Kleiman N.S., Coselli J.S., Gleason T.J., Lee J.S., et al. CoreValve USCI. 3-Year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J. Am. Coll. Cardiol. 2016;67:2565–2574. doi: 10.1016/j.jacc.2016.03.506. - DOI - PubMed
    1. Smith C.R., Leon M.B., Mack M.J., Miller D.C., Moses J.W., Svensson L.G., Tuzcu E.M., Webb J.G., Fontana G.P., Makkar R.R., et al. PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011;364:2187–2198. doi: 10.1056/NEJMoa1103510. - DOI - PubMed
    1. Vahanian A., Beyersdorf F. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur. Heart J. 2022;43:561–632. doi: 10.1093/eurheartj/ehab395. - DOI - PubMed
    1. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K., Thourani V.H., Tuzcu E.M., Miller D.C., Herrmann H.C., et al. PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 2016;374:1609–1620. doi: 10.1056/NEJMoa1514616. - DOI - PubMed

LinkOut - more resources