Author + information
- Gerhard Schymik1,
- Peter Bramlage2,
- Valentin Herzberger1,
- Jens Bergmann1,
- Lars Conzelmann3,
- Alexander Würth4,
- Holger Schroefel5,
- Claus Schmitt1 and
- Panagiotis Tzamalis1
- 1Medical Clinic IV - Department of Cardiology, Municipal Hospital Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
- 2Institut für Pharmakologie und Präventive Medizin, Cloppenburg, Germany
- 3Helios Clinic for Cardiac Surgery Karlsruhe, Germany, Karlsruhe, Germany
- 4Medical Clinic III - Department of Cardiology, Vincentius Hospital Karlsruhe, Karlsruhe, Germany
- 5Cardiac Surgery, University Heart Center Freiburg/Bad Krozingen, Germany, Bad Krozingen, Germany
Use of transcatheter aortic valve implantation (TAVI) to treat severe aortic stenosis (AS) has gained popularity over time, accompanied by an evolution of patient and clinical factors. We aimed to characterise these changes and evaluate their impact on TAVI outcomes.
Prospective, single center registry of 2,000 consecutive patients undergoing TAVI between May 2008 and March 2015. Patients were divided into four cohorts of 500 consecutive implantations each: cohort I: 04/2008–07/2010; cohort II: 07/2010–04/2012; cohort III: 04/2012–10/2013; cohort IV: 10/2013–03/2015
Overall, the mean age was 81.8 years, without significant variation across cohorts. The proportion of females was higher for cohort I (62.8%) than for the later three cohorts (50 to 52.4%, p<0.001). Compared to cohort I, prior myocardial infarction (5.4% vs. 11.0%; p<0.001) and NYHA class IV (10.0% vs. 3.6%; p<0.001) were less common in cohort IV. Across cohorts, there was a fall in baseline EuroSCORE (from 24.3% to 18.7%), frailty (from 48.4% to 17.0%), and use of transapical access (from 43.6% to 29.0%), while transfemoral access increased (from 56.4% to 71.0%; p<0.001 for each). Periprocedurally, there was a fall in moderate/severe aortic regurgitation (from 3.2% to 0.0%) and rate of unplanned cardiopulmonary bypass (from 4.0% to 1.0%; both p<0.001). A similar trend applied to 30-day rate of major vascular complications (from 5.2% to 1.8%; p=0.006), life-threatening bleeding (from 7.0% to 3.0%; p<0.001) and cardiovascular mortality (from 4.4% to 1.8%; p=0.020). One year post-TAVI, mortality and stroke rates did not differ, though major vascular complications and life-threatening/major bleeding were less common in more recent cohorts. Device success according to VARC-2 criteria increased slightly from cohort I to II (86.2% to 91.4%; p=0.012) with no significant further changes in cohorts III and IV (89.6% and 90.2%). During the first 30 days after the TAVI procedure, there was a non-significant trend towards reduction over time of the proportion of patients who experienced 1 or more event included in the VARC-2 early safety composite endpoint (cohort I: 16%, cohort IV:12%, p=0.068).
Over a time of seven years of TAVI patients have less comorbidity regarding EuroSCORE and frailty. The use of transfemoral implantations rise up significantly and there are significant improvements in cardiovascular mortality, device success, bleeding and vascular complications and moderate/severe valve regurgitation. The stroke and pacemaker rates shows no changes and are further an unresolved problem.
STRUCTURAL: Valvular Disease: Aortic