title: Trends over the past 4 years in population characteristics, 30-day outcomes and 1-year survival in patients treated with transcatheter aortic valve implantation.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is recommended in patients with severe aortic stenosis that is either inoperable or at high-risk for surgical valve replacement.
  
  
  OBJECTIVE
  To evaluate trends in the feasibility and safety of transfemoral TAVI over the past 4 years.
  
  
  METHODS
  Between 2010 and 2013, all consecutive patients undergoing TAVI in our institution were included in a prospective registry. Population characteristics and 30-day and 1-year outcomes were analysed. Outcomes were classified according to the Valve Academic Research Consortium-2.
  
  
  RESULTS
  Overall, 429 patients underwent TAVI; transfemoral access was used in 368 (85.7%). The proportion of patients treated via a transfemoral approach increased (70.1% to 89.9%; P<0.0001) and the use of prior balloon aortic valvuloplasty decreased (44.7% to 11.2%; P<0.0001). The mean logistic EuroSCORE decreased significantly from 19.4±10.9% to 15.8±8.7% (P=0.01). The 30-day mortality rate did not change significantly (6.4% vs. 5.6%; P=0.99). Similarly, rates of major vascular complications (12.8% vs. 15.4%; P=0.87) and stroke (2.1% vs. 1.4%; P=0.75) remained unchanged. Mean length of stay after TAVI decreased significantly from 8.9±11.3 days to 4.8±4.7 days (P=0.002) and 72 (50.3%) patients were discharged early in 2013. One-year survival increased significantly from 81.0% to 94.4% (P=0.03).
  
  
  CONCLUSIONS
  Over the past 4 years, TAVI has been increasingly performed using a transfemoral approach. Treated patients are at lower-risk with less co-morbidity. Thirty-day mortality and complications remained unchanged, but length of stay after TAVI and 1-year mortality decreased dramatically.
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Avinée
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France. Electronic address: eric.durand@chu-rouen.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Durand
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Safwane
authors.initials: S
authors.lastname: Elhatimi
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Bauer
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Bastien
authors.initials: B
authors.lastname: Glinel
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Dacher
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cellier
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Viart
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tron
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Godin
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Litzler
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cribier
authors.affiliation: Centre Hospitalier Universitaire Charles-Nicolle, Université de Rouen, Inserm U1096, Rouen, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011474:Prosthesis Design; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D065467:Transcatheter Aortic Valve Replacement / Q000639:trends*; D016896:Treatment Outcome
keywords: Aortic stenosis; Rétrécissement aortique; TAVI; VARC-2