Among patients undergoing TAVR, advances in device technology and procedural factors contributed to the majority of observed improvement in short-term outcomes while changing patient characteristics had an increased impact on improved outcomes at one year, according to a recent study published in Circulation: Cardiovascular Interventions.

Using data captured by the STS/ACC TVT Registry, Suzanne V. Arnold, MD, et al., looked at 161,196 patients undergoing TAVR at 596 sites over a six-year period, employing logistic regression to determine the impact of each mediator cluster – demographics, noncardiovascular comorbidities, cardiovascular comorbidities, device-related factors, and nondevice-related procedural factors – on improved TAVR outcomes over time.

Results showed that outcomes improved steadily from 2012 to 2018, including 30-day mortality (6.7% to 2.4%), 30-day composite adverse events (25.3% to 10.5%), and one-year mortality (19.9% to 10.1%; p< 0.001 for all). The authors write, “In sequential models, the unadjusted odds ratio for 30-day mortality was 0.82 per year (95% CI, 0.80-0.84), which was progressively attenuated with addition of each covariate cluster.”

Most improvement in 30-day mortality was attributable to device factors and nondevice procedural factors, with similar results for 30-day composite adverse events; however, not all improvement was explainable by factors included in the analysis, indicating improved technical skill likely had additional impact. When looking at one-year outcomes, patient and procedural factors exhibited similar contributions on improvement over time, pointing to patient characteristics like younger age, healthier status and lower risk having greater impact on longer term outcomes.

The study also identified lessons to apply to the development of other transcatheter valve therapies, highlighting efforts to focus on reducing short-term complications identified as having impact on long-term survival and health status.

“As structural cardiology expands into the treatment of other forms of valvular heart disease, following this paradigm – identifying the complications with the greatest negative impact on survival and health status and adapting devices and procedural care to reduce these – is likely to remain an effective approach for quickly improving both short- and long-term outcomes of these procedures,” state Arnold, et al.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Demography, Cardiology, Registries, Heart Valve Diseases, Logistic Models, Odds Ratio, Transcatheter Aortic Valve Replacement, STS/ACC TVT Registry, National Cardiovascular Data Registries

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