Temporal changes of patient characteristics over 12 years in a single-center transcatheter aortic valve implantation cohort

• Published in: Clinical research in cardiology Vol. 112; no. 5; pp. 691 - 701
• Main Authors: Demal, Till Joscha, Weimann, Jessica, Ojeda, Francisco Miguel, Bhadra, Oliver D., Linder, Matthias, Ludwig, Sebastian, Grundmann, David, Voigtländer, Lisa, Waldschmidt, Lara, Schirmer, Johannes, Schofer, Niklas, Blankenberg, Stefan, Reichenspurner, Hermann, Conradi, Lenard, Seiffert, Moritz, Schaefer, Andreas
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.05.2023; Springer Nature B.V
• Subjects: Access routes; Age; Aged, 80 and over; Aorta; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - etiology; Aortic Valve Stenosis - surgery; Cardiology; Cardiovascular diseases; Child; Heart diseases; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Heart valves; Humans; Implantation; Medicine; Medicine & Public Health; Original Paper; Pacemakers; Patients; Retrospective Studies; Rheumatic heart disease; Risk assessment; Risk Factors; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; User experience; Low risk; Surgical risk; TAVR; TAVI; Guidelines
• ISSN: 1861-0684; 1861-0692; 1861-0692
• DOI: 10.1007/s00392-023-02166-8

Background Beneficial results of transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. Aim To examine influence of these guideline changes on a real-world TAVI cohort, we evaluated how risk profiles and outcomes of TAVI patients developed in our single-center patient cohort over a period of 12 years. Methods Baseline, procedural and 30-day outcome parameters of TAVI patients were retrospectively compared between three time periods (period 1: 2008–2012, period 2: 2013–2017, period 3: 2018–2020). Results Between 03/2008 and 12/2020, a total of 3678 patients underwent TAVI at our center. The median age was 81.1 years (25th, 75th percentile: 76.7, 84.9) with no significant change over time. The EuroSCORE II showed a continuous and significant decline from 5.3% (3.3, 8.6) in period 1 to 2.8% (1.7, 5.0) in period 3 ( p <  0.001). Furthermore, rates of permanent pacemaker implantation, acute kidney injury, and paravalvular leakage ≥ moderate continuously declined over time. Accordingly, the 30-day mortality fell from 9.3% in period 1 to 4.3% in period 3 ( p <  0.001). Conclusion Despite substantial guideline alterations, median patient age remained largely unchanged in our TAVI cohort over the past 12 years. Therefore, increased age still appears to be the main reason to choose TAVI over SAVR. However, risk profiles declined substantially. Significant improvements in early outcomes suggest favorable influence of less invasive access routes, improved device platforms and growing user experience. Graphical abstract