TAVI in the UK, 2007-2012 | Journal Scan
What are the trends in the performance of transcatheter aortic valve implantation (TAVI) in the United Kingdom, from the first case in 2007 to the end of 2012?
The UK TAVI data set was collected using a web-based interface from the National Institute of Cardiovascular Outcomes Research (NICOR). Only patients with a valve implanted in the aortic position were included. Annual cohorts were examined for case mix, complications, outcomes to 6 years, and predictors of mortality. Mortality outcomes were analyzed in the 92% of patients from England and Wales for whom independent mortality tracking was available.
A total of 3,980 TAVI procedures were performed. In successive years, there was an increase in frequency of impaired left ventricular function, but no change in Logistic EuroSCORE. Overall 30-day mortality was 6.3%; 30-day mortality was highest in the first cohort (2007/8), after which there were no further significant changes. One-year survival was 81.7%, falling to 37.3% at 6 years. The rate of hospital discharge by day 5 post-TAVI increased from 16.7% in 2007/8 to 28% in 2012. The only multivariate preprocedural predictor of 30-day mortality was Logistic EuroSCORE ≥40. During long-term follow-up, multivariate predictors of mortality were preprocedural atrial fibrillation, chronic obstructive pulmonary disease, creatinine >200 μmol/L, diabetes, and coronary artery disease. The strongest independent procedural predictor of long-term mortality was periprocedural stroke (hazard ratio 3.00, p < 0.0001). Nonfemoral access and postprocedural aortic regurgitation also were significant predictors of adverse outcome.
This is an analysis of TAVI in the entire UK, with follow-up over 6 years. Although clinical profiles of enrolled patients remained unchanged, longer-term outcomes improved, and patients were discharged earlier. Periprocedural stroke, nonfemoral access, and postprocedure aortic regurgitation were predictors of adverse outcome, along with intrinsic patient risk factors.
TAVI was introduced in the UK in 2007; access initially was limited to the Sapien prosthesis, with later access to Sapien XT and CoreValve. These data demonstrate an early decline in 30-day mortality, presumably due to operator experience. Procedural mortality was predicted by the Logistic EuroSCORE; as anticipated, later mortality was affected by comorbid conditions including history of stroke, diabetes, concomitant lung or kidney disease, atrial fibrillation, and coronary artery disease.
Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atherosclerotic Disease (CAD/PAD), Atrial Fibrillation/Supraventricular Arrhythmias, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Coronary Artery Disease, Interventions and Structural Heart Disease
Keywords: Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis, Aortic Valve Insufficiency, England, Wales, Atrial Fibrillation, Coronary Artery Disease, Diabetes Mellitus, Stroke, Pulmonary Disease, Chronic Obstructive, Risk Factors, Creatinine
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