Temporal Changes of Patient Characteristics Over 12 Years in a Single-Center Transcatheter Aortic Valve Implantation Cohort

Background: Beneficial results of transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in patients at all risk strata have led to substantial changes in guideline recommendations for valvular heart disease. 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.

Method: 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) reflecting the updates of the European guidelines on valvular heart disease in 2012, 2014, and 2021.

Results: Between March 2008 and December 2020, a total of 3,678 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). The rate of transfemoral access shows a substantial and statistically significant increase from 42.0% (n = 303) in period 1 to 95.5% (n = 1095) in period 3 (p < 0.001). Correspondingly, the rate of transapical access declined from 57.1% (n = 412) to 2.4% (n = 27, p < 0.001). All observed complication rates did either significantly decrease or remained stable over time. Rates of permanent pacemaker implantation (period 1: 19.3%, period 2: 16.1%, period 3: 9.8%; p < 0.001), acute kidney injury (period 1: 7.8%, period 2: 4.9%, period 3: 3.7%; p = 0.002), and paravalvular leakage ≥ moderate (period 1: 7.2%, period 2: 5.1%, period 3: 1.7%, p < 0.001) continuously and significantly declined over time. The VARC-3 device success rate increased from 87.5% in period 1 to 95.4% in period 3 (p < 0.001). 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.

Publication History

Article published online:
28 January 2023