Background:
Transcatheter Aortic Valve Implantation (TAVI) has emerged as an alternative to open heart surgery in patient with aortic stenosis at high and intermediate surgical risk. Recently indication has expanded to patients at lower risk and internal quality review of TAVI programs is mandatory in order to treat younger patients at low surgical risk
Objectives:
To retrospectively evaluates procedural and 1-year outcomes of patients who underwent TAVI in the CHUV and compare these results with large multicentric international registries.
Methods:
We collected baseline clinical data as well as procedural (including immediate and in-hospital complications) and 1-year outcomes (vital status and permanent pacemaker) of patients who underwent TAVI in the CHUV in 2019 and 2020 and who where included in the Swiss TAVI registry. These results were then compared with three large international registries (STS-ACC TVT, France- TAVI and OCEAN-TAVI) and the landmark PARTNER 3 clinical trial.
Results:
Between January 1st 2019 and December 31st 2020, 249 patients underwent TAVI in the CHUV. Of these, 133 were included in the present work. Mean STS score was 4.3% with 58.6% being at low- risk (STS < 4%). In-hospital death occurred in one case (0.8%), 6% of patients had bleeding requiring transfusion and vascular complications had an occurrence of 5.3%. Stroke or transient ischemic attack (TIA) were observed in a total of 5.3% of the patients. In total, 18.8% of the patients required pacemaker implantation for new-onset conduction disorder. At 1 year, 9.8% of the patients had died and an additional 3.2% required pacemaker implantation. Mortality rate was thus lower than in the registries used for comparison while vascular complication occurred at a similar rate. On the other hand, pacemaker implantation and stroke rate were higher in our cohort. When looking only at low- risk patients, our cohort had higher death, stroke rate and pacemaker implantation than what was observed in the landmark PARTNER 3 trial.
Conclusion:
Patients undergoing TAVI in the CHUV have lower risk of 1-year death but higher risk of stroke and pacemaker implantation than what was observed in larger registries. Among low-risk patients, all- cause death rate was higher than in the PARTNER 3 trial, but cardiovascular mortality was similar, suggesting that non-cardiovascular comorbidities were responsible for this difference, as PARTNER 3 included a highly selected and younger population. Enhanced patient triage with the use of frailty tools might help identify patients at high-risk of non-cardiovascular mortality despite a low STS score.