An Analysis of Activity, Trends, and Outcomes in 36,026 Patients Who Underwent Aortic Valve Intervention in the 5 Years from 2006–2010
Purpose: The interventional management of aortic valve disease is changing rapidly with the advent and growth of TAVI and marked changes in population demographics. The purpose of this study was to describe trends in activity levels, demographics, and clinical outcomes of all patients who underwent aortic valve implantation (by surgical- or catheter-based approaches) during the first few years of TAVI rollout in the UK.
Methods: All cardiac surgical procedures and all catheter-based implants (TAVIs) in the UK were entered into national registries hosted by NICOR (National Institute for Cardiovascular Outcomes Research). These registries have the same infrastructure and contain the same demographic data with compatible definitions. All aortic valve interventions between 1/1/2006 and 1/1/2011 were included in this analysis. Near 100% mortality tracking was effected for both registries.
Results: 35,406 patients underwent AVR or AVR & CABG (SAVR); 1,620 underwent TAVI. The numbers of SAVR peaked in 2008 then declined slightly (for the first time ever in the UK). There was a steady growth in TAVI, peaking in 2010 when TAVI represented just over 10% of all AV interventions. There was almost a 100% increase in all AV interventions in patients >80 years (from 1,055 up to 2,035 in 2010). This increase was 50% due to an increase in TAVI and 50% SAVR. There was a very marked variation in the rate of uptake of TAVI by geographical region. The TAVI cohort had a much greater risk profile even in the patients >80 or over. The 30-day and 1-year mortality was predictably higher in the TAVI cohort, but this decreased markedly from 13.9% in 2007 to 6.2% in 2010.
Conclusions: This study provides detailed insight into the evolution of aortic intervention during the introduction of TAVI and is relatively unique in capturing all interventional activity during this period in a defined population.