title: Evaluation of current practices in transcatheter aortic valve implantation: The WRITTEN (WoRldwIde TAVI ExperieNce) survey.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has been adopted worldwide as the standard treatment for severe aortic stenosis in symptomatic patients at prohibitive or high surgical risk, but there are still several areas where consensus and evidence are lacking. The purpose was to obtain a global view of current practice related to TAVI with the potential to identify the main areas of consensus and divergence between centers.
  
  
  METHODS
  An online questionnaire was distributed in centers performing TAVI including a total of 59 questions concerning pre-procedural evaluation, procedural practices and post-procedural management.
  
  
  RESULTS
  The survey was completed by 250 centers (with a cumulative experience of nearly 70,000 TAVI) from 38 different countries. Heart team meetings and surgical risk scores were routinely performed in most (>95%) centers, but frailty (44%) and quality of life (28%) assessments were less frequently performed. General anesthesia remained the most frequent type of anesthesia (60% of centers), and significant variability was detected in the examinations for residual aortic regurgitation assessment during the procedure and in post-procedural ECG monitoring and temporary pacemaker implementation (from none to ≥72h post-TAVI). Dual antiplatelet therapy duration post-TAVI was highly variable (1, 3, and ≥6months in 14%, 41% and 32% of centers, respectively) and lack of consensus in antithrombotic regimen was observed in patients with atrial fibrillation requiring anticoagulation therapy (anticoagulation alone, anticoagulation+aspirin, anticoagulation+clopidogrel, and triple therapy in 28%, 37%, 26% and 4% of centers, respectively).
  
  
  CONCLUSIONS
  The WRITTEN survey provided extensive data on current TAVI-related practice and identified important differences between centers in key aspects of pre-, intra-, and post-operative management. This highlights the urgent need for further studies and evidence-based data to guide multiple aspects of the TAVI field.
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Unified Interventional Cardiology Unit, San Luigi Gonzaga Orbassano University Hospital, Rivoli Infermi Hospital, Turin, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Cerrato
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: luisnombela@yahoo.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela-Franco
authors.affiliation: Columbia University Medical Center, NewYork-Presbyterian Hospital, the Cardiovascular Research Foundation, NY, New York, USA.
authors.forename: Tamim M
authors.initials: TM
authors.lastname: Nazif
authors.affiliation: Cardiology department, Charles Nicolle Hospital, University of Rouen, Rouen, France.
authors.forename: Helene
authors.initials: H
authors.lastname: Eltchaninoff
authors.affiliation: The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
authors.affiliation: Heart Institute (InCor), São Paulo University Medical School (USP), São Paulo, Brazil.
authors.forename: Henrique B
authors.initials: HB
authors.lastname: Ribeiro
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Barbanti
authors.affiliation: University Heart Center, Hospital Zurich, Zurich, Switzerland.
authors.forename: Fabian
authors.initials: F
authors.lastname: Nietlispach
authors.affiliation: Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: De Jaegere
authors.affiliation: St. Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Agostoni
authors.affiliation: Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
authors.forename: Ramiro
authors.initials: R
authors.lastname: Trillo
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Jimenez-Quevedo
authors.affiliation: University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.affiliation: Clinica Alemana, Santiago, Chile.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.affiliation: West China Hospital, Sichuan University, China.
authors.forename: Mao
authors.initials: M
authors.lastname: Chen
authors.affiliation: Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Tamburino
authors.affiliation: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: Columbia University Medical Center, NewYork-Presbyterian Hospital, the Cardiovascular Research Foundation, NY, New York, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.
authors.forename: Josep
authors.initials: J
authors.lastname: Rodes-Cabau
mesh_terms: D001024:Aortic Valve Stenosis / Q000601:surgery*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D018579:Patient Selection; D011182:Postoperative Care; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires; D065467:Transcatheter Aortic Valve Replacement
chemical_list: D005343:Fibrinolytic Agents
keywords: Real world assessment valvular stenosis; TAVI; TAVR; Web-based survey