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Trends in Complications and Outcomes of TAVR
Study Questions:
What are the trends in outcomes and complications related to transcatheter aortic valve replacement (TAVR)?
Methods:
This study examined 1,063 patients enrolled in a nonrandomized continued access registry of individuals treated with a balloon-expandable TAVR using a transfemoral artery approach, and compared procedural complications and outcomes over time.
Results:
Over the time of the study, there was an increase in age, with decreased Society of Thoracic Surgeons risk score, prevalence of a porcelain aorta, presence of lung disease, history of chest wall radiation or deformities, prior neurologic event, and proportion of patients deemed inoperable (p < 0.05 for each); other characteristics remained similar. During this period, there were significant decreases in need for post-dilatation and surgical cut-down for access, with increased procedural and device success (p < 0.05 for each). Over time, there was a 33% decrease in adjusted all-cause mortality (p = 0.04), and decreased prevalence of moderate or severe paravalvular regurgitation (19.2% vs. 10.1% for initial and final periods, p < 0.001).
Conclusions:
There were changes in patient selection and decreases in mortality and significant paravalvular regurgitation with TAVR over time.
Perspective:
These results suggest an evolution in patient selection for TAVR over time. There was a trend toward performing TAVR in lower-risk patients, which was associated with increased procedural success and reduced complications. Even after adjusting for clinical variables, a decrease in all-cause mortality was observed, suggesting that this is multifactorial, and is likely due to both better patient selection and improved procedural success. This supports the importance of TAVR performance at high-volume and highly experienced sites, as well as continued improvements in our ability to identify patients most likely to benefit from TAVR.
Keywords: Aortic Valve Insufficiency, Aortic Valve Stenosis, Cardiac Surgical Procedures, Dilatation, Heart Valve Diseases, Lung Diseases, Mortality, Transcatheter Aortic Valve Replacement
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