Activity and outcomes for aortic valve implantations performed in England and Wales since the introduction of transcatheter aortic valve implantation.
OBJECTIVE
The first transcatheter aortic valve implantation (TAVI) in England and Wales was performed in 2007. This study presents the subsequent national activity and outcomes for both TAVI and aortic valve replacement (AVR).


METHODS
Data for all AVR and TAVI procedures between January 2006 and December 2012 in England and Wales were included. The number of procedures, patient characteristics, in-hospital and 30-day mortality, postoperative length of stay (PLOS) and survival were analysed separately for: isolated AVR; AVR + coronary artery bypass graft (CABG) surgery; AVR + other surgery and TAVI.


RESULTS
The number of TAVIs increased from 66 in 2007 (0.8% of all implants) to 1186 in 2012 (10.9% of all implants). AVR activity also increased over the study period. TAVI patients were older and had a higher mean logistic EuroSCORE than all AVR groups. The 30-day mortality rates were 2.1% for isolated AVR, 3.9% for AVR + CABG, 7.7% for AVR + other surgery and 6.2% for TAVI. In-hospital mortality has significantly improved for all groups. The 5-year survival rates were 82.6% for isolated AVR, 81.7% for AVR + CABG, 74.5% for AVR + other surgery and 46.1% for TAVI. The median PLOS after TAVI was similar to that of isolated AVR but shorter than that of the other AVR groups.


CONCLUSIONS
Since the introduction of TAVI, there has been an increase in both TAVI and AVR activity. TAVIs now represent over 10% of all aortic valve implants. There are distinct differences between procedural groups with respect to patient risk factors. Outcomes for all procedural groups have improved, but long-term TAVI results are required before its role in the treatment of aortic stenosis can be fully defined.
Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK.
Stuart W
SW
Grant
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, The Farr Institute @ HeRC, Liverpool, UK.
Graeme L
GL
Hickey
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK.
Peter
P
Ludman
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.
Neil
N
Moat
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK.
David
D
Cunningham
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK.
Mark
M
de Belder
Department of Cardiology, Leeds General Infirmary, Leeds, UK.
Daniel J
DJ
Blackman
Department of Cardiology, Sussex Cardiac Centre, Brighton, UK.
David
D
Hildick-Smith
Department of Cardiothoracic Surgery, Barts Health, St Bartholomew's Hospital, London, UK William Harvey Research Institute and NIHR Cardiovascular Biomedical Research Unit, Barts and the London School of Medicine, London, UK.
Rakesh
R
Uppal
National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK Department of Cardiothoracic Services, The James Cook University Hospital, Middlesbrough, UK.
Simon
S
Kendall
Department of Cardiothoracic Surgery, Manchester Academic Health Science Centre, University of Manchester, University Hospital of South Manchester, Manchester, UK National Institute for Cardiovascular Outcomes Research (NICOR), University College London, London, UK ben.bridgewater@uhsm.nhs.uk.
Ben
B
Bridgewater
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery; D004739:England; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014852:Wales
Aortic stenosis; Aortic valve; Outcomes; Survival; Transcatheter aortic valve implantation; Trends