Risk assesment in TAVI including valve-in-valve
Impact of experience on TAVI outcome: a propensity-matched analysis from the pragmatic plus initiative
Aims: To evaluate the impact of growing experience and technological refinements with transfemoral transcatheter aortic valve implantation (TF-TAVI) on clinical outcome in patients with symptomatic severe aortic stenosis (AS).
Methods and results: We retrospectively analysed 793 consecutive TF-TAVI patients from four European centres and evaluated experience in three propensity-score-matched cohorts subcategorised based on enrolment date. Three propensity-score-matched cohorts of 214 TF-TAVI patients were identified. With mounting experience and moving from the initial to the last cohort, all-cause 30-day mortality tended to be lower (7.0% in T1 vs. 3.7% in T3, p=0.16) but with improved 1-year survival (79% vs. 86%, p=0.016). Over time there were significantly fewer major vascular complications (15% vs. 7.9%, p=0.023), life-threatening (17.8% vs. 7.9%, p=0.003) and major bleedings (22.4% vs. 12.1%, p=0.007). Major vascular complications and life-threatening bleedings due to closure device failure decreased significantly (9.2% vs. 3.1%, p=0.01 and 5.7% vs. 1%, p=0.01, respectively).The combined safety endpoint dropped from 31.3% in T1 to 17.8% in T3 (p<0.001). By multivariable analysis (including adjustment for arterial sheath size) the last cohort as compared to the initial cohort was associated with significant reductions in 30-day mortality (OR 0.35, 95% CI 0.12 - 0.96), stage 3 AKI (OR 0.12, 95% CI 0.29 - 0.93) and the combined safety endpoint (OR 0.52, 95% CI 0.29 - 0.93).
Conclusions: Growing TAVI experience results in significant reductions in major vascular complications, including life-threatening bleedings as well as the combined clinical safety endpoint and improved 1-year survival.
