Transcatheter Aortic Valve Implantation (TAVI) Outcomes In Ontario

BACKGROUND: Transcatheter aortic valve implantation (TAVI)
has emerged as a treatment for many severe symptomatic aortic
stenosis patients who cannot tolerate conventional aortic valve
surgery. Although TAVI has been demonstrated in landmark
trials to be effective, it is uncertain whether these results can be
generalized to the real world because of the substantial differences in patients enrolled in clinical trials as compared to those
encountered in clinical practice. Accordingly, our main objective was to evaluate the clinical outcome of a population-based
cohort of patients undergoing TAVI in Ontario, Canada.
METHODS: We made use of the data from Canadian Cardiovascular Network of Ontario (CCN), which has assembled an ongoing
clinical TAVI registry including all procedures performed in the
province. These data were subsequently linked to the Canadian Institute for Hospital Information hospital discharge abstract database
and the Registered Persons Database to determine clinical outcomes.
RESULTS: Among the 293 patients undergoing TAVI procedures
and had at least one year of follow-up, their mean age was 82 years
and 48% of the patients were female. TAVI was performed via the
trans-femoral approach in 61% and the trans-apical approach in
39%. The average length of stay was 13 days and the rate of stroke
was 4.4% at 30 days and 6.1% at 1 year. The all-cause mortality
rate after TAVI was 7.5% at 30 days and 20.5% at 1 year. To put
these mortality rates into context, the mortality rate following
valve implantation in PARTNER B, which evaluated patients
who could not undergo conventional surgery was 6.4% at 30 days
and 30.7% at 1 year after randomization.
CONCLUSIONS: In this population-cohort of elderly patients undergoing TAVI procedures in Ontario, we found clinical outcomes that are comparable to those observed in clinical trials.