Transcatheter aortic valve implantation outcomes – a national health insurance database analysis

Aortic stenosis (AS) affects 2% of people ≥65 years and 4% aged ≥85 years. National data on the success and outcomes of implantation with self-expanding (SE) and balloon-expandable) BE (valves in Israel are unavailable. Therefore the study objective was to compare the long-term mortality and morbidity after TAVI with SE and BE valves in a real-world setting.

The Maccabi Health Service (MHS) database was used to identify all MHS members who underwent TAVI between 1st January 2015 and 31st December 2018 ;

Baseline characteristics including age, body mass index, socioeconomic status, co-morbid conditions, medical history were comparable between groups.

Results: The cohort included 550 patients with severe symptomatic AS, who underwent TAVI at all institutes performing the procedure, 260 SE & 290 BE. All-cause mortality within one-year (hazard ratio [HR], 0.7; 95% CI 0.4–1.3; p=0.3), two-years (HR, 0.8; 95% CI 0.5–1.2; p=0.3), and five-years (HR, 0.9; 95% CI 0.6–1.4; p=0.8) of TAVI were similar between the SE and BE groups. There was no statistically significant difference between groups in the occurrence of atrial fibrillation, myocardial infarction, endocarditis, transient ischemic attack/stroke or increase in stage of chronic kidney disease. Patients with BE valves were significantly less likely to undergo pacemaker implantation within 90 days of TAVI.

In conclusion: TAVI is a safe and effective treatment for AS.

It appears that SE and BE valves have a similar beneficial clinical profile with an increase in pacemaker rates in patients receiving SE valves.