Temporal Trends in Adoption and Outcomes of Transcatheter Aortic Valve Implantation: A Swisstavi Registry Analysis.

Aims

To describe temporal trends in adoption and performance of transcatheter aortic valve implantation (TAVI) in Switzerland over a period of 5 years.

Methods and Results

Between 2011 and 2015, a total of 3'493 patients were consecutively included in the SwissTAVI Registry (NCT01368250) and analyzed for the purpose of this study. The primary outcome measure was all-cause mortality at 1-year after TAVI. Over the five-year period, a six-fold increase in the number of procedures was observed, whereas the baseline surgical risk estimated by the Society of Thoracic Surgeon (STS) score declined (from 6.8 ± 4.4% to 4.6 ± 3.6, p < 0.001). Overall, 1-year mortality amounted to 12.8%; mortality was highest in the first annual cohorts (14.6%, 14.8% and 15.9% in 2011, 2012 and 2013, respectively) and decreased to 13.4% in 2014 and 9.7% in 2015, with a significant temporal trend. While rates of cerebrovascular events, peri-procedural myocardial infarction, moderate/severe paravalvular regurgitation and stage 3 acute kidney injury did not significantly change over time, a significant reduction in life threatening or major bleeding was noted during the latest compared with earlier years of recruitment.

Conclusions

This long-term recruitment analysis of a national TAVI registry showed rapid adoption paralleled by a progressive decrease of patients' baseline risk profile. Early and late survival significantly improved over time as did the rate of life threatening or major bleeding.