title: Temporal trends in transcatheter aortic valve implantation, 2008-2014: patient characteristics, procedural issues, and clinical outcome.
abstract: BACKGROUND
  About a decade past the first transcatheter aortic valve implantation (TAVI), data are limited regarding temporal trends accompanying its evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI registry.
  
  
  OBJECTIVE
  TAVI is changing and improving with time.
  
  
  METHODS
  Patients who underwent TAVI between January 2008 and December 2014 at 3 high-volume Israeli centers were divided into 5 time quintiles according to procedure date. Outcomes were analyzed and reported according to Valve Academic Research Consortium-2.
  
  
  RESULTS
  A total of 1285 patients were studied (43% male; mean age, 83 ± 3 years; mean Society of Thoracic Surgeons [STS] score, 5.5 ± 3.6). Over time, there was a shift toward treating patients at lower STS score, increased use of conscious sedation and transfemoral approach, and decreased use of balloon predilatation. The balloon-expandable to self-expandable valve utilization ratio decreased, the valve-in-valve experience increased from 4% to 17% of all TAVI volume, and length of hospital stay was halved (P = 0.006). Kaplan-Meier survival curves showed gradual decrease in mortality risk (P = 0.031), but there was no significant 1-year mortality decrease by multivariable analysis. Each year increment was associated with an adjusted 20%, 15%, and 12% decrease in new pacemaker obligation (P = 0.004), new pacemaker obligation or left bundle branch block (P = 0.008), and in-hospital infections (P = 0.082), respectively.
  
  
  CONCLUSIONS
  Temporal trends accompanying TAVI evolution include its utilization in lower-risk patients, procedural simplification, improved overall survival, decreased pacemaker obligation, and shorter hospital stay.
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Uri
authors: U
authors: Landes
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Alon
authors: A
authors: Barsheshet
authors: Department of Cardiology, Tel Aviv Medical Center, Israel.
authors: Ariel
authors: A
authors: Finkelstein
authors: Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors: Victor
authors: V
authors: Guetta
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Abid
authors: A
authors: Assali
authors: Department of Cardiology, Tel Aviv Medical Center, Israel.
authors: Amir
authors: A
authors: Halkin
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Hanna
authors: H
authors: Vaknin-Assa
authors: Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors: Amit
authors: A
authors: Segev
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Tamir
authors: T
authors: Bental
authors: Department of Cardiology, Tel Aviv Medical Center, Israel.
authors: Jeremy
authors: J
authors: Ben-Shoshan
authors: Leviev Heart Center, Sheba Medical Center, Ramat Gan, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors: Israel M
authors: IM
authors: Barbash
authors: Department of Cardiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
authors: Ran
authors: R
authors: Kornowski
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007557:Israel / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome
keywords: Aortic disease; Cardiac; Valvular heart disease; catheterization/diagnostic interventional