期刊
HEART LUNG AND CIRCULATION
卷 30, 期 8, 页码 1213-1220出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hlc.2021.02.007
关键词
Aortic stenosis; Transcatheter aortic valve implantation; Cardiac outcomes
The number of TAVI procedures in New South Wales increased tenfold between 2013 and 2017 statewide, with mortality rates comparable to international cohorts at short and medium-term follow-up. Heart failure, chronic kidney disease, and requirement for ventilation post-TAVI were independent predictors of in-hospital death and at 180 days.
Background The increasing implementation of transcatheter aortic valve implantation (TAVI) in Australia warrants real-world data on the prevalence and outcomes of these patients. The aim of this study is to describe trends in case-volumes of TAVI in New South Wales (NSW), Australia and associated mortality outcomes. Methods From the Centre of Health Record Linkage registry, all NSW residents who underwent TAVI between 5 June 2013 and 30 June 2018 were identified. Cause-specific mortality was tracked from the statewide death registry. Temporal trends in case-volumes between 2013 and 2018 were assessed by linear regression. Binary logistic regression was used to compare differences in in-hospital and 30-day mortality, while Cox proportional hazards regression was used to compare mortality beyond 30 days. Results Case-volumes increased from 30 in 2013 to 345 by 2017. The cohort comprised 1,098 persons (mean[6SD] age: 83.3 +/- 7.7 yrs). Cumulative in-hospital, 180-day and at end-of-study (mean: 1.8 +/- 1.2 yrs) all-cause mortality were 1.3% (n=14), 4.9% (n=54) and 20.3% (n=224) respectively. Heart failure (14.3%, n=2), myocardial infarction (14.3%, n=2), and sepsis (14.3%, n=2) were the primary causes of in-hospital death. Post-discharge, sepsis (25.2%, n=53) was the main cause-specific death, while combined cardiovascular deaths accounted for 46% (n=97), mostly from heart failure (n=35). Heart failure, chronic kidney disease, and requirement for ventilation post-TAVI were independent predictors of in-hospital death and at 180 days. TAVI procedure in low-volume public centres was a predictor of mortality at 180 days. Conclusion The number of TAVI procedures increased 10-fold between 2013 and 2017 state-wide, with mortality rates comparable to international cohorts at short and medium-term follow-up. Pre-existing comorbidities and site-specific caseloads may be important determinants of outcome, emphasising the importance of appropriate patient selection and treating centre.
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