Abstract 15930: Temporal Trends and Reasons for Deferring Patients From Transcatheter Aortic Valve Replacement in the United States
Introduction: The number of available options for transcatheter aortic valve replacement (TAVR) has increased in the past few years. However, the number of patients excluded remains uncertain.
Hypothesis: We sought to describe the temporal changes of causes of exclusion from TAVR.
Methods: We retrospectively analyzed all patients who were referred to our center from January 1st 2010 to July 31st 2013. Reasons for exclusion were divided into cardiac causes, valvular (significant mitral disease, aortic regurgitation and annulus size), unsuitable for TAVR (echocardiographic [area <0.8cm2, peak velocity and/or mean gradient >40 mm Hg] or low Society of Thoracic Surgeons’ score) and inadequate access.
Results: Overall 1,051 patients were referred with approximately 70 to 90% of the population were excluded from TAVR at the initial screening visit (figure panel A). Of that population, 26% (n=280) were excluded due to cardiac causes, 18% (n=190) due to valvular causes, 21% (n=216) were unsuitable and 6.3% (n=66) due inadequate access. Baseline characteristics including Echo indices were similar among groups. As seen in the figure (panel B), the number of patients excluded from cardiac causes, valvular causes and those unsuitable for TAVR has been lower overtime. However, the number of patients excluded due to inadequate access remained unchanged (p=0.42).
Conclusions: Under the existing TAVR device availability in the US and with restricted labeling, the overall number of patients deferred from TAVR over the past three years remains high. The current device profiles are still prohibitive for many patients to undergo TAVR via the transfemoral approach. Further, device iterations and flexibility of the inclusion criteria are warranted to expand TAVR use to more patients presenting with symptomatic aortic stenosis.
Author Disclosures: R.O. Escarcega: None. R. Torguson: None. J. Salmon: None. S. Kumar: None. M.A. Magalhaes: None. N.C. Baker: None. S. Minha: None. T. Lhermusier: None. H. Ota: None. L. Satler: None. A. Pichard: None. I. Ben-Dor: None. R. Waksman: None.
- © 2014 by American Heart Association, Inc.