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TAVI in the UK, 2007-2012 | Journal Scan
Study Questions:
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?
Methods:
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.
Results:
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.
Conclusions:
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.
Perspective:
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.
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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