TRANSCATHETER AORTIC VALVE REPLACEMENT ON THE RISE: TRENDS AND OUTCOMES NATIONALLY

Background: Transcatheter aortic valve replacement (TAVR) is an increasingly common procedure. While it is currently recommended for patients with severe aortic stenosis with high or intermediate surgical risk, it is currently being studied in lower risk patients. If approved for expanded use, it stands to become even more commonplace in hospitals around the country. We present here a descriptive analysis of national data on changes in demographics, co-morbidities, and outcomes of patients undergoing TAVR from 2012 compared to 2017.

Methods: Data on demographic, baseline health status, and outcomes of all patients undergoing TAVR procedures during 2012 and 2017 was obtained from The National Cardiovascular Data Registry (NCDR). We analyzed trends between 2012 and 2017 and present a descriptive analysis of the data.

Results: The number of patients undergoing TAVR annually increased 14 fold between 2012 and 2017, from 3,251 patients annually to 45,395. More TAVRs are being performed on younger patients with the percentage of TAVRs placed in patients under the age of 80 increasing from 29.1% in 2012 to 41% in 2017. The number of patients who received a TAVR after a surgical aortic valve replacement increased from 51 to 2,677 which represents a 52 fold increase. The baseline rates of prior stroke, TIA, peripheral arterial disease, hypertension, diabetes, end stage renal disease and chronic lung disease have not changed substantially between 2012 and 2017. The use of general anesthesia intra-procedurally has decreased from 96.8% to 55.9% and post-operative mortality has decreased from 5.7% to 1.7%.

Conclusions: Transcatheter aortic valve replacement is increasingly common, with a substantial increase in patients under the age of 80 undergoing the procedure in recent years. Overall, overall the procedure has become shorter, with less use of general anesthesia and lower post-operative mortality. Continued monitoring of long term outcomes and complications will be particularly important as the demographics of recipients shifts to a younger cohort.