Temporal Trends in Transcatheter Aortic Valve Implantation in Israel 2008-2014: Patient Characteristics, Procedural Issues and Clinical Outcome

Background: About a decade past the first transcatheter aortic valve implantation (TAVI), there is limited data about the temporal trends accompanying its’ evolution from novel technology to mainstream therapy. We evaluated these trends in a large multicenter TAVI-registry.

Methods: Patients who underwent TAVI between Jan-2008-to-Dec-2014 at 3 highest-volume Israeli centers [Rabin, Sheba & Sourasky] were divided into 5 time-quintiles according to procedural date (Q1: 2008-2010, n=260; Q2: 2011, n=251; Q3: 2012, n=266; Q4: 2013, n=261; Q5: 2014, n=248). Outcomes were analyzed and reported according to the Valve-Academic-Research-Consortium-2 definitions.

Results: A total of 1,285 patients were studied: 43% males, age 83±3 years, STS-score 5.5±3.6. Throughout the years there was a shift to treat lower estimated surgical-risk patients (STS score, p<0.001) and a gradual increase in aortic-valve-area (p<0.001). There was an escalated practice of conscious sedation and transfemoral approach and less balloon pre-dilatation convention. The balloon-expandable-to-self-expandable valve utilization ratio decreased from 3.5 to 2.3 and the Valve-in-valve experience sprout from 4% to 17% of all-TAVI volume, p=

Conclusions: Temporal-trends accompanying TAVI evolution in 3 leading Israeli sites include utilization in patients at lower surgical risk and increased practice of conscious sedation and valve-in-valve procedures. Over time, TAVI is being conducted with shorter hospital stay and with less complications. Most importantly, post-TAVI survival is cultivating.