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Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome.

Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome.
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Landes U, Barsheshet A, Finkelstein A, Guetta V, Assali A, Halkin A, Vaknin-Assa H, Segev A, Bental T, Ben-Shoshan J, Barbash IM, Kornowski R,


Landes U, Barsheshet A, Finkelstein A, Guetta V, Assali A, Halkin A, Vaknin-Assa H, Segev A, Bental T, Ben-Shoshan J, Barbash IM, Kornowski R, (click to view)

Landes U, Barsheshet A, Finkelstein A, Guetta V, Assali A, Halkin A, Vaknin-Assa H, Segev A, Bental T, Ben-Shoshan J, Barbash IM, Kornowski R,

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Clinical cardiology 2016 Oct 26() doi 10.1002/clc.22632
Abstract
BACKGROUND
About a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry.

HYPOTHESIS
TAVI is changing and improving with time.

METHODS
Patients who underwent TAVI between January 2008 and December 2014 at 3 high-volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium-2.

RESULTS
A total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon-expandable to self-expandable valve utilization ratio decreased, the valve-in-valve experience increased from 4% to 17% of all TAVI volume, and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival curves showed gradual decrease in mortality risk (P = 0.031), but there was no significant 1-year mortality decrease by multivariable analysis. Each year increment was associated with an adjusted 20%, 15%, and 12% decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation or left bundle branch block (P = 0.008), and in-hospital infections (P = 0.082), respectively.

CONCLUSIONS
Temporal trends accompanying TAVI evolution include its utilization in lower-risk patients, procedural simplification, improved overall survival, decreased pacemaker obligation, and shorter hospital stay.

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