Transcatheter Aortic Valve Implantation in the UK: Temporal Trends, Predictors of Outcome and 6 Year Follow Up: A Report from the UK TAVI Registry 2007 to 2012
Background—We assessed trends in the performance of TAVI in the United Kingdom from the first case in 2007 to the end of 2012. We analysed changes in case mix, complications, outcomes to six years and predictors of mortality.
Methods and Results—Annual cohorts were examined. Mortality outcomes were analysed in the 92% of patients from England and Wales for whom independent mortality tracking was available. 3,980 TAVI procedures were performed. In successive years there was an increase in frequency of impaired left ventricular function, but no change in Logistic EuroSCORE (LES). Overall 30-day mortality was 6.3%; highest in the first cohort (2007/8), after which there were no further significant changes. One year survival was 81.7%, falling to 37.3% at 6 years. Discharge by day 5 rose from 16.7% in 2007/8 to 28% in 2012. The only multivariate pre-procedural predictor of 30 day mortality was LES ≥ 40. During long-term follow-up, multivariate predictors of mortality were pre-procedural atrial fibrillation, chronic obstructive pulmonary disease, creatinine > 200 µmol/l, diabetes and coronary artery disease. The strongest independent procedural predictor of long term mortality was peri-procedural stroke (HR=3.00, p<0.0001). Non-femoral access and post-procedural aortic regurgitation were also significant predictors of adverse outcome.
Conclusions—We analysed TAVI in an entire country, with follow up over 6 years. Although clinical profiles of enrolled patients remained unchanged, longer term outcomes improved, and patients were discharged earlier. Peri-procedural stroke, non-femoral access and post-procedure aortic regurgitation are predictors of adverse outcome, along with intrinsic patient risk factors.
- Received October 27, 2014.
- Revision received January 17, 2015.
- Accepted January 26, 2015.