Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
Statistical Methods
3. Results
3.1. Baseline Characteristics
3.2. Procedural Outcomes
3.3. Hospitalization Features
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Members, A.F.; Vahanian, A.; Alfieri, O.; Andreotti, F.; Antunes, M.J.; Barón-Esquivias, G.; Baumgartner, H.; Borger, M.A.; Carrel, T.P.; de Bonis, M.; et al. Guidelines on the management of valvular heart disease (version 2012) The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur. Heart J. 2012, 33, 2451–2496. [Google Scholar]
- Leon, M.B.; Smith, C.R.; Mack, M.J.; Makkar, R.R.; Svensson, L.G.; Kodali, S.K.; Thourani, V.H.; Tuzcu, E.M.; Miller, D.C.; Herrmann, H.C.; et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N. Engl. J. Med. 2016, 374, 1609–1620. [Google Scholar] [CrossRef] [PubMed]
- Spears, J.; Al-Saiegh, Y.; Goldberg, D.; Manthey, S.; Goldberg, S. TAVR: A Review of Current Practices and Considerations in Low-Risk Patients. J. Interv. Cardiol. 2020, 2020, e2582938. [Google Scholar] [CrossRef] [PubMed]
- Smith, C.R.; Leon, M.B.; Mack, M.J.; Miller, D.C.; Moses, J.W.; Svensson, L.G.; Tuzcu, E.M.; Webb, J.G.; Fontana, G.P.; Makkar, R.R.; et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. N. Engl. J. Med. 2011, 364, 2187–2198. [Google Scholar] [CrossRef] [PubMed]
- Vahanian, A.; Beyersdorf, F.; Praz, F.; Milojevic, M.; Baldus, S.; Bauersachs, J.; Capodanno, D.; Conradi, L.; De Bonis, M.; De Paulis, R.; et al. 2021 ESC/EACTS Guidelines for the Management of Valvular Heart Disease. Eur. Heart J. 2022, 43, 561–632. Available online: https://academic.oup.com/eurheartj/article/43/7/561/6358470?login=true (accessed on 24 April 2022). [CrossRef]
- Nishimura, R.A.; Otto, C.M.; Bonow, R.O.; Carabello, B.A.; Erwin, J.P.; Fleisher, L.A.; Jneid, H.; Mack, M.J.; McLeod, C.J.; O’Gara, P.T.; et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease. J. Am. Coll. Cardiol. 2017, 70, 252–289. [Google Scholar] [CrossRef]
- Kodali, S.K.; Williams, M.R.; Smith, C.R.; Svensson, L.G.; Webb, J.G.; Makkar, R.R.; Fontana, J.P.; Dewey, T.M.; Thourani, V.H.; Pichard, A.D.; et al. Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve Replacement. N. Engl. J. Med. 2012, 366, 1686–1695. [Google Scholar] [CrossRef]
- Kappetein, A.P.; Head, S.J.; Généreux, P.; Piazza, N.; van Mieghem, N.M.; Blackstone, E.H.; Brott, T.G.; Cohen, D.J.; Cutlip, D.E.; van Es, G.-A.; et al. Updated Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation: The Valve Academic Research Consortium-2 Consensus Document (VARC-2). Eur. J. Cardiothorac. Surg. 2012, 42, S45–S60. Available online: https://pubmed.ncbi.nlm.nih.gov/23026738/ (accessed on 30 June 2020). [CrossRef]
- Standardized Endpoint Definitions for Transcatheter Aortic Valve Implantation Clinical Trials: A Consensus Report from the Valve Academic Research Consortium. Journal of the American College of Cardiology. Available online: https://www.jacc.org/doi/abs/10.1016/j.jacc.2010.12.005 (accessed on 27 November 2021).
- Clinical Outcomes after Transcatheter Aortic Valve Replacement Using Valve Academic Research Consortium Definitions: A Weighted Meta-Analysis of 3519 Patients from 16 Studies. Journal of the American College of Cardiology. Available online: https://www.jacc.org/doi/abs/10.1016/j.jacc.2012.02.022 (accessed on 27 November 2021).
- Evolution of Outcome and Complications in TAVR: A Meta-Analysis of Observational and Randomized Studies. Scientific Reports. Available online: https://www.nature.com/articles/s41598-020-72453-1 (accessed on 25 November 2021).
- Holmes, D.R.; Nishimura, R.A.; Grover, F.L.; Brindis, R.G.; Carroll, J.D.; Edwards, F.H.; Peterson, E.D.; Rumsfeld, J.S.; Shahian, D.M.; Thourani, V.H.; et al. Annual Outcomes with Transcatheter Valve Therapy. J. Am. Coll. Cardiol. 2015, 66, 2813–2823. [Google Scholar] [CrossRef]
- In-Hospital and Mid-Term Predictors of Mortality after Transcatheter Aortic Valve Implantation: Data from the TAVI National Registry 2010–2011—ScienceDirect. Available online: https://www.sciencedirect.com/science/article/abs/pii/S1885585713002405 (accessed on 25 November 2021).
- Walther, T.; Hamm, C.W.; Schuler, G.; Berkowitsch, A.; Kötting, J.; Mangner, N.; Mudra, H.; Beckmann, A.; Cremer, J.; Welz, A.; et al. Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements. J. Am. Coll. Cardiol. 2015, 65, 2173–2180. [Google Scholar] [CrossRef]
- Auffret, V.; Lefevre, T.; Van, B.E.; Eltchaninoff, H.; Iung, B.; Koning, R.; Motreff, P.; Leprince, P.; Verhoye, J.P.; Manigold, T.; et al. Temporal Trends in Transcatheter Aortic Valve Replacement in France. J. Am. Coll. Cardiol. 2017, 70, 42–55. [Google Scholar] [CrossRef] [PubMed]
- Avinée, G.; Durand, E.; Elhatimi, S.; Bauer, F.; Glinel, B.; Dacher, J.-N.; Cellier, G.; Viart, G.; Tron, C.; Godin, M.; et al. Trends over the past 4 years in population characteristics, 30-day outcomes and 1-year survival in patients treated with transcatheter aortic valve implantation. Arch. Cardiovasc. Dis. 2016, 109, 457–464. [Google Scholar] [CrossRef] [PubMed]
- Van Kesteren, F.; van Mourik, M.S.; Wiegerinck, E.M.A.; Vendrik, J.; Piek, J.J.; Tijssen, J.G.; Koch, K.T.; Henriques, J.P.S.; Wykrzykowska, J.J.; de Winter, R.J.; et al. Trends in patient characteristics and clinical outcome over 8 years of transcatheter aortic valve implantation. Neth. Heart J. 2018, 26, 445–453. [Google Scholar] [CrossRef] [PubMed]
- Salemi, A.; Sedrakyan, A.; Mao, J.; Elmously, A.; Wijeysundera, H.; Tam, D.Y.; Di Franco, A.; Redwood, S.; Girardi, L.N.; Fremes, S.E.; et al. Individual Operator Experience and Outcomes in Transcatheter Aortic Valve Replacement. JACC Cardiovasc. Interv. 2019, 12, 90–97. [Google Scholar] [CrossRef]
- Toutouzas, K.; Benetos, G.; Voudris, V.; Drakopoulou, M.; Stathogiannis, K.; Latsios, G.; Synetos, A.; Antonopoulos, A.; Kosmas, E.; Iakovou, I.; et al. Pre-Dilatation Versus No Pre-Dilatation for Implantation of a Self-Expanding Valve in All Comers Undergoing TAVR: The DIRECT Trial. JACC Cardiovasc. Interv. 2019, 12, 767–777. [Google Scholar] [CrossRef]
- Siontis, G.C.M.; Jüni, P.; Pilgrim, T.; Stortecky, S.; Büllesfeld, L.; Meier, B.; Wenaweser, P.; Windecker, S. Predictors of permanent pacemaker implantation in patients with severe aortic stenosis undergoing TAVR: A meta-analysis. J. Am. Coll. Cardiol. 2014, 64, 129–140. [Google Scholar] [CrossRef]
- Mazzella, A.J.; Hendrickson, M.J.; Arora, S.; Sanders, M.; Li, Q.; Vavalle, J.P.; Gehi, A.K. Shifting Trends in Timing of Pacemaker Implantation after Transcatheter Aortic Valve Replacement. JACC Cardiovasc. Interv. 2021, 14, 232–234. [Google Scholar] [CrossRef]
- Al-Ogaili, A.; Fugar, S.; Okoh, A.; Kolkailah, A.A.; Al Hashemi, N.; Ayoub, A.; Russo, M.J.; Kavinsky, C.J. Trends in complete heart block after transcatheter aortic valve replacement: A population based analysis. Catheter. Cardiovasc. Interv. 2019, 94, 773–780. [Google Scholar] [CrossRef]
- Konigstein, M.; Ben-Assa, E.; Banai, S.; Shacham, Y.; Ziv-Baran, T.; Abramowitz, Y.; Steinvil, A.; Rubinow, E.L.; Havakuk, O.; Halkin, A.; et al. Periprocedural Bleeding, Acute Kidney Injury, and Long-term Mortality after Transcatheter Aortic Valve Implantation. Can. J. Cardiol. 2015, 31, 56–62. [Google Scholar] [CrossRef]
- Steinvil, A.; Leshem-Rubinow, E.; Halkin, A.; Abramowitz, Y.; Ben-Assa, E.; Shacham, Y.; Bar-Dayan, A.; Keren, G.; Banai, S.; Finkelstein, A. Vascular Complications after Transcatheter Aortic Valve Implantation and Their Association with Mortality Reevaluated by the Valve Academic Research Consortium Definitions. Am. J. Cardiol. 2015, 115, 100–106. [Google Scholar] [CrossRef]
- Mangieri, A.; Montalto, C.; Poletti, E.; Sticchi, A.; Crimi, G.; Giannini, F.; Latib, A.; Capodanno, D.; Colombo, A. Thrombotic Versus Bleeding Risk after Transcatheter Aortic Valve Replacement. J. Am. Coll. Cardiol. 2019, 74, 2088–2101. [Google Scholar] [CrossRef] [PubMed]
- Barbanti, M.; Binder, R.; Freeman, M.; Wood, D.; Leipsic, J.; Cheung, A.; Ye, J.; Toggweiler, S.; Webb, J. Impact of Low–Profile Sheaths on Vascular Complication and Bleeding During Transfemoral Transcatheter Aortic Valve Replacement. J. Am. Coll. Cardiol. 2013, 61, E1887. [Google Scholar] [CrossRef]
- Noad, R.L.; Johnston, N.; McKinley, A.; Dougherty, M.; Nzewi, O.; Jeganathan, R.; Manoharan, G.; Spence, M.S. A pathway to earlier discharge following TAVI: Assessment of safety and resource utilization. Catheter. Cardiovasc. Interv. 2016, 87, 134–142. [Google Scholar] [CrossRef] [PubMed]
- Serletis-Bizios, A.; Durand, E.; Cellier, G.; Tron, C.; Bauer, F.; Glinel, B.; Dacher, J.-N.; Cribier, A.; Eltchaninoff, H. A Prospective Analysis of Early Discharge after Transfemoral Transcatheter Aortic Valve Implantation. Am. J. Cardiol. 2016, 118, 866–872. [Google Scholar] [CrossRef] [PubMed]
- Arora, S.; Strassle, P.D.; Kolte, D.; Ramm, C.J.; Falk, K.; Jack, G.; Caranasos, T.G.; Cavender, M.A.; Rossi, J.S.; Vavalle, J.P. Length of Stay and Discharge Disposition after Transcatheter Versus Surgical Aortic Valve Replacement in the United States. Circ. Cardiovasc. Interv. 2018, 11, e006929. [Google Scholar] [CrossRef]
1988 | Group 1 (2009–2012) n = 321 | Group 2 (2013–2015) n = 482 | Group 3 (2016–2018) n = 565 | Group 4 (2019–2021) n = 620 | p Value (for Trend) |
---|---|---|---|---|---|
Age (years), mean ± SD | 84.4 ± 5.6 | 83.7 ± 6.2 | 82.1 ± 6.3 | 80.3 ± 6.6 | <0.0001 |
Gender (female), n (%) | 193 (60) | 253 (53) | 294 (52) | 272 (44) | <0.0001 |
Body mass index (kg/m2), median (IQR) | 26.6 (23.9–29.8) | 26.2 (23.5–29.6) | 26.6 (24.1–29.7) | 26.9 (24.1–30.1) | 0.19 |
Body surface area(m2), mean ± SD | 1.79 ± 0.21 | 1.80 ± 0.19 | 1.81 ± 0.21 | 1.85 ± 0.21 | <0.0001 |
EuroSCORE 2, median (IQR) | 4.6 (3.0–7.3) | 4.3 (2.6–7.4) | 3.4 (2.2–5.6) | 2.8 (1.8–5.1) | <0.0001 |
NYHA functional class > 2 | 312 (97) | 412 (86) | 480 (85) | 458 (74) | <0.0001 |
Prior stroke/TIA, n (%) | 34 (11) | 73 (15) | 75 (13) | 63 (10) | 0.31 |
Diabetes mellitus, n (%) | 104 (32) | 191 (40) | 203 (36) | 234 (38) | 0.34 |
Hypertension, n (%) | 282 (88) | 420 (87) | 470 (84) | 500 (81) | 0.001 |
Frailty, n (%) | 43 (13) | 116 (24) | 178 (31) | 148 (24) | 0.001 |
Chronic obstructive pulmonary disease, n (%) | 63 (20) | 56 (12) | 53 (9) | 51 (8) | <0.0001 |
Chronic dialysis, n (%) | 5 (1.6) | 10 (2.1) | 15 (2.7) | 14 (2.3) | 0.46 |
Atrial fibrillation/flutter, n (%) | 97 (30) | 158 (33) | 146 (26) | 172 (28) | 0.11 |
Coronary artery disease, n (%) | 184 (57) | 299 (62) | 241 (43) | 290 (47) | <0.0001 |
Prior myocardial infarction, n (%) | 51 (16) | 96 (20) | 53 (9) | 17 (5) | <0.0001 |
Prior CABG n (%) | 51 (16) | 77 (16) | 79 (14) | 80 (24) | - |
Prior pacemaker/ICD, n (%) | 27 (8) | 66 (14) | 93 (17) | 88 (14) | 0.02 |
Prior valve intervention (non aortic valve), n (%) | 2 (0.6) | 11 (2.3) | 6 (1.1) | 15 (2.4) | 0.16 |
Hemoglobin (g/dL), mean ± SD | 11.9 ± 1.4 | 11.9 ± 1.5 | 12.1 ± 1.6 | 12.6 ± 1.6 | <0.0001 |
Creatinine (mg/dL), median (IQR) | 1.2 (1.0–1.4) | 1.1 (0.9–1.4) | 1.0 (0.8–1.3) | 0.9 (0.8–1.3) | <0.0001 |
eGFR (MDRD formula, mL/min/1.732), mean ± SD | 49.7 ± 14.7 | 55.1 ± 19.7 | 62.5 ± 21.6 | 64.4 ± 23.4 | <0.0001 |
Aspirin | 219 (68) | 329 (68) | 330 (58) | 350 (56) | <0.0001 |
Beta blockers | 170 (53) | 290 (60) | 314 (55) | 331 (53) | 0.42 |
ACEI/ARB | 188 (59) | 284 (59) | 235 (42) | 139 (22) | <0.0001 |
Statins | 217 (68) | 346 (71) | 387 (69) | 388 (63) | 0.02 |
Baseline RBBB, n (%) | Missing | 30 (6.2) | 66 (11.7) | 59 (9.5) | 0.09 |
Baseline LAHB, n (%) | Missing | 36 (7.5) | 32 (5.7) | 36 (5.8) | 0.28 |
Baseline RBBB and LAHB, n (%) | Missing | 10 (2.1) | 16 (2.8) | 14 (2.3) | 0.89 |
Baseline echocardiographic parameters | |||||
Ejection fraction ≤ 45%, n (%) (Semiquantitative) | 24 (7.5) | 50 (10.4) | 54 (9.6) | 49 (7.9) | 0.76 |
Aortic valve peak pressure (mmHg), mean ± SD | 78.1 ± 22.8 | 74.6 ± 22.5 | 74.8 ± 22.1 | 77.8 ± 20.2 | 0.87 |
Aortic valve mean pressure (mmHg), mean ± SD | 47.5 ± 14.7 | 45.8 ± 14.7 | 45.2 ± 14.4 | 47.7 ± 13.7 | 0.98 |
Aortic valve area (cm2), mean ± SD | 0.69 ± 0.18 | 0.74 ± 0.18 | 0.75 ± 0.16 | 0.72 ± 0.19 | 0.11 |
Systolic pulmonary artery pressure (mmHg), median (IQR) | 39 (30–50) | 38 (30–50) | 37 (31–49) | 37 (30–49) | 0.71 |
n = 1988 | Group 1 (2009–2012) n = 321 | Group 2 (2013–2015) n = 482 | Group 3 (2016–2018) n = 565 | Group 4 (2019–2021) n = 620 | p Value (for Trend) |
---|---|---|---|---|---|
Balloon pre-dilatation, n (%) | 317 (99) | 345 (72) | 148 (26) | 113 (18) | <0.0001 |
Balloon post-dilatation, n (%) | 3 (0.9) | 34 (7.1) | 164 (29) | 88 (14) | <0.0001 |
Contrast volume (mL), median (IQR) | 140 (115–168) | 150 (121–165) | 162 (140–197) | 156 (135–186) | <0.0001 |
Fluoroscopy time (min), mean ± SD | 16.4 ± 5.9 | 16.1 ± 5.5 | 15.1 ± 6.9 | 15.2 ± 6.9 | 0.01 |
Valve type | <0.0001 | ||||
Edwards lifesciences | 65 (20) | 191 (40) | 246 (44) | 269 (48) | |
Medtronic | 254 (80) | 274 (57) | 314 (55.5) | 254 (45) | |
Other | 0 (0) | 15 (3) | 3 (0.5) | 37 (7) | |
Valve size | 26.7 ± 1.9 | 26.6 ± 2.1 | 27.1 ± 2.5 | 27.2 ± 3.0 | <0.0001 |
Device success (VARC2), n (%) | 309 (96.3) | 459 (95.2) | 554 (98.1) | 615 (99.2) | <0.0001 |
Perivalvular leak ≥ moderate (per angio) | 9 (2.8) | 4 (0.8) | 4 (0.7) | 0 (0) | <0.0001 |
Need for 2nd valve, n (%) | 3 (0.9) | 10 (2.1) | 6 (1.1) | 9 (1.5) | 0.98 |
Conversion to open surgery, n (%) | 1 (0.3) | 2 (0.4) | 3 (0.5) | 1 (0.2) | 0.66 |
Need for cardiopulmonary bypass, n (%) | 0 (0) | 0 (0) | 1 (0.2) | 1 (0.2) | 0.32 |
Coronary obstruction, n (%) | 1 (0.3) | 1 (0.2) | 0 (0) | 2 (0.3) | 0.99 |
Ventricular septal perforation, n (%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | - |
Mitral valve damage, n (%) | 1 (0.3) | 1 (0.2) | 0 (0) | 0 (0) | 0.09 |
Tamponade, n (%) | 3 (0.9) | 8 (1.7) | 4 (0.7) | 3 (0.5) | 0.15 |
Annular rupture, n (%) | 0 (0) | 3 (0.6) | 0 (0) | 0 (0) | 0.22 |
Valve malpositioning, n (%) | 0 (0) | 0 (0) | 3 (0.5) | 0 (0) | 0.68 |
Valve migration or embolization, n (%) | 4 (1.2) | 5 (1.0) | 0 (0) | 5 (0.8) | 0.26 |
Procedural CPR, n (%) | 0 (0) | 1 (0.2) | 1 (0.2) | 4 (0.6) | 0.08 |
Procedural VT/VF(requiring treatment), n (%) | 1 (0.3) | 4 (0.8) | 3 (0.5) | 5 (0.8) | 0.55 |
LVOT obstruction, n (%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | - |
n = 1988 | Group 1 (2009–2012) n = 321 | Group 2 (2013–2015) n = 482 | Group 3 (2016–2018) n = 565 | Group 4 (2019–2021) n = 620 | p Value (for Trend) |
---|---|---|---|---|---|
New LBBB, n (%) (only patients with no prior LBBB, n = 1867) | 64 (19) | 100 (22) | 143 (28) | 89 (15) | 0.12 |
New RBBB, n (%) (only patients with no prior RBBB, n = 1833) | 12 (3.7) | 10 (2.2) | 10 (2.0) | 3 (0.5) | 0.001 |
New AVB ≥ 2 degree, n (%) (only patients with no prior pacemaker, n = 1714) | 44 (15.0) | 47 (11.3) | 40 (8.5) | 36 (6.8) | <0.0001 |
New CAVB, n (%) (only patients with no prior pacemaker, n = 1714) | 38 (12.9) | 39 (9.4) | 35 (7.4) | 32 (6.0) | <0.0001 |
New need for PPM, n (%) (only patients with no prior pacemaker, n = 1714) | 71 (24.1) | 77 (18.5) | 87 (18.4) | 37 (7.0) | <0.0001 |
Major or life-threatening bleeding, n (%) | 35 (10.9) | 38 (7.9) | 16 (2.8) | 11 (1.8) | <0.0001 |
Major vascular complications, n (%) | 28 (8.7) | 31 (6.4) | 6 (1.1) | 44 (7.1) | 0.16 |
Acute kidney injury ≥ Stage 1, n (%) | 44 (13.7) | 77 (16.0) | 29 (5.1) | 7 (1.1) | <0.0001 |
Acute kidney injury ≥ Stage 2, n (%) | 4 (1.2) | 9 (1.9) | 9 (1.6) | 0 (0) | 0.02 |
Acute dialysis, n (%) (only patients without chronic dialysis, n = 1944) | 1 (0.3) | 0 (0) | 1 (0.2) | 2 (0.3) | 0.63 |
Periprocedural MI ( <72 h), n (%) | 0 (0) | 0 (0) | 1 (0.2) | 0 (0) | 0.81 |
Spontaneous MI ( >72 h), n (%) | 0 (0) | 0 (0) | 0 (0) | 0 (0) | - |
Periprocedural CVA/TIA, n (%) | 5 (1.6) | 5 (1.0) | 13 (2.3) | 3 (0.5) | 0.32 |
Days until discharge (days), mean ± SD | 7.0 ± 7.1 | 5.4 ± 3.9 | 4.8 ± 5.3 | 2.3 ± 1.7 | <0.0001 |
Post-procedural echocardiography | |||||
Ejection fraction ≤ 45%, n (%) (n = 1576) | 8 (6.3) | 24 (6.3) | 28 (5.3) | 33 (6.1) | 0.88 |
Ejection fraction (%), mean ± SD, (n = 1091) | 57.1 ± 6.7 | 56.5 ± 6.8 | 56.9 ± 6.9 | 56.4 ± 6.9 | 0.66 |
Aortic stenosis ≥ mild, n (%), (n = 703) | 23 (79) | 102 (75) | 33 (61) | 4 (0.8) | <0.0001 |
Aortic stenosis ≥ moderate, n (%), (n = 703) | 3 (10.3) | 4 (2.9) | 1 (1.9) | 1 (0.2) | <0.0001 |
Paravalvular leak ≥ mild, n (%), (n = 1467) | 224 (74) | 322 (71) | 93 (46) | 27 (5.4) | <0.0001 |
Paravalvular leak ≥ mild-to-moderate, n (%), (n = 1467) | 9 (3) | 38 (8.3) | 18 (8.8) | 15 (3.0) | 0.29 |
Aortic valve peak pressure (mmHg), mean ± SD, (n = 1553) | 17.8 ± 9.3 | 18.4 ± 10.1 | 17.9 ± 10.1 | 19.1 ± 8.5 | 0.21 |
Aortic valve mean pressure (mmHg), mean ± SD, (n = 1508) | 9.8 ± 5.3 | 10.3 ± 5.9 | 10.2 ± 6.2 | 10.7 ± 4.6 | 0.13 |
Aortic valve area cm (mean ± SD), (n = 324) | - | - | 1.86 ± 0.49 | 1.78 ± 0.45 | - |
Systolic pulmonary artery pressure (mmHg), median (IQR) | 39 (31–46) | 39 (31–49) | 37 (31–47) | 37 (31–46) | 0.31 |
Procedural mortality, n (%) | 0 (0) | 6 (1.2) | 1 (0.2) | 3 (0.5) | 0.89 |
In-hospital mortality, n (%) | 5 (1.6) | 4 (0.8) | 6 (1.1) | 1 (0.2) | 0.03 |
Variable | Univariate HR (CI) p Value | Multivariate Model 2 HR (CI) p Value | Multivariate Model 1 HR (CI) p Value |
---|---|---|---|
TAVR (years) | 0.94 (0.92–0.97) <0.001 | -------- | 0.95 (0.92–0.98) 0.004 |
TAVR (groups) | 0.84 (0.77–0.92) <0.001 | 0.85 (0.76–0.94) 0.002 | -------- |
Male Gender | 1.21 (1.05–1.39) 0.008 | 1.29 (1.09–1.52) 0.002 | 1.28 (1.09–1.51) 0.003 |
Age | 1.04 (1.03–1.05) <0.001 | 1.02 (1.01–1.04) 0.001 | 1.02 (1.01–1.04) <0.001 |
BMI (kg/m) | 0.98 (0.97–0.99) 0.03 | 0.99 (0.98–1.02) 0.833 | 0.99 (0.98–1.015) 0.84 |
EuroSCORE 2 | 1.04 (1.03–1.05) <0.001 | 0.99 (0.98–1.01) 0.602 | 0.99 (0.98–1.01) 0.63 |
NYHA class | 2.15 (1.57–2.94) <0.001 | 1.76 (1.26–2.46) 0.001 | 1.76 (1.26–2.47) 0.001 |
Prior CVA | 1.31 (1.07–1.59) 0.008 | 1.1 (0.89–1.36) 0.359 | 1.11 (0.9–1.37) 0.32 |
Diabetes mellitus | 1.20 (1.04–1.39) 0.01 | 1.16 (0.99–1.36) 0.62 | 1.17 (0.99–1.37) 0.59 |
Frailty | 1.52 (1.29–1.78) <0.001 | 1.32 (1.1–1.58) 0.002 | 1.31 (1.09–1.56) 0.003 |
COPD | 1.54 (1.27–1.86) <0.001 | 1 | 1.46 (1.19–1.76) <0.001 |
Chronic dialysis | 2.67 (1.77–4.01) <0.001 | 2.06 (1.32–3.24) 0.002 | 2.09 (1.33–3.27) 0.001 |
Atrial fibrillation or flutter | 1.62 (1.39–1.88) <0.001 | 1.41 (1.2–1.65) <0.001 | 1.41 (1.2–1.65) <0.001 |
Coronary artery disease | 1.28(1.11–1.47) 0.001 | 1.06 (0.89–1.25) 0.48 | 1.06 (0.89–1.25) 0.48 |
Prior myocardial infraction | 1.62(1.34–1.94) <0.001 | 1.18 (0.96–1.47) 0.11 | 1.18 (0.96–1.47) 0.11 |
Pacemaker/ICD | 1.62(1.34–1.94) <0.001 | 1.28 (1.03–1.59) 0.26 | 1.27 (1.02–1.58) 0.31 |
Left bundle branch block | 0.77(0.64–0.93) 0.007 | 1.02 (0.82–1.27) 0.82 | 0.99 (0.8–1.22) 0.95 |
Baseline LVEF < 45% | 1.49(1.19–1.87) <0.001 | 0.96 (0.73–1.3) 0.77 | 0.96 (0.73–1.26) 0.79 |
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Frydman, S.; Zahler, D.; Merdler, I.; Freund, O.; Shacham, Y.; Banai, S.; Finkelstein, A.; Steinvil, A. Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience. J. Clin. Med. 2022, 11, 4962. https://doi.org/10.3390/jcm11174962
Frydman S, Zahler D, Merdler I, Freund O, Shacham Y, Banai S, Finkelstein A, Steinvil A. Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience. Journal of Clinical Medicine. 2022; 11(17):4962. https://doi.org/10.3390/jcm11174962
Chicago/Turabian StyleFrydman, Shir, David Zahler, Ilan Merdler, Ophir Freund, Yacov Shacham, Shmuel Banai, Ariel Finkelstein, and Arie Steinvil. 2022. "Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience" Journal of Clinical Medicine 11, no. 17: 4962. https://doi.org/10.3390/jcm11174962
APA StyleFrydman, S., Zahler, D., Merdler, I., Freund, O., Shacham, Y., Banai, S., Finkelstein, A., & Steinvil, A. (2022). Temporal Trends of Transcatheter Aortic Valve Implantation over 12 Years: A High-Volume Single-Center Experience. Journal of Clinical Medicine, 11(17), 4962. https://doi.org/10.3390/jcm11174962