Transcatheter Valve Therapy Registry Outcomes

Study Questions:

What are the current practice and trends for transcatheter valve therapy (TVT) in the United States?

Methods:

The Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT Registry captured 26,414 procedures as of December 31, 2014. Temporal trends were compared between 2012 and 2013 versus 2014.

Results:

Comparison of the two time intervals revealed that transcatheter aortic valve replacement (TAVR) patients remain elderly (mean age 82 years), with multiple comorbidities (reflected by high mean STS-predicted risk of mortality [STS PROM] scores for surgical AVR [8.3%]), were highly symptomatic (New York Heart Association class III/IV in 82.5%), frail (slow 5-meter walk test in 81.6%), and had poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and increased femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), but site-reported rates of stroke remain stable at 2.2%.

Conclusions:

The authors concluded that the STS/ACC TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary clinical practice in the United States, and that it can be used to identify trends in practice and opportunities for quality improvement.

Perspective:

After an introduction in the US that involved actual prospective randomized clinical trials, transcatheter therapies (and TAVR in particular) now join the existing world of data on heart valve intervention: the world is not static, and both devices and user expertise change even before data are published. A large registry has the ability to capture ongoing trends in use and outcomes, as much as the self-reported data accurately reflect all clinical use.

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

Keywords: Cardiovascular Surgical Procedures, Comorbidity, Conscious Sedation, Frail Elderly, Geriatrics, Heart Valve Diseases, Quality Improvement, Stroke, Transcatheter Aortic Valve Replacement


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