Transcatheter Aortic Valve Implantation: Selection, Early Mortality, and Complications. A Multicenter Evaluation of More Than 33 000 Implantations (2013–2023).

Abstract

Transcatheter aortic valve implantation (TAVI) has become the standard treatment of persons aged 75 and above with severe aortic valvular stenosis. In this study, we analyzed temporal trends in risk profiles and treatment results from 2013 to 2023. We carried out a retrospective analysis of patient characteristics, periprocedural complications, and 30-day mortality after 33 079 TAVI procedures that were carried out in seven German cardiac care centers. TAVI case numbers rose from 1605 in 2013 to 4459 in 2023. The mean age of the patients remained constant at 81 years, while the operative risk (STS score) fell from 5.9% to 4.1%. The percentage of low-risk patients (STS < 4%) rose from 47% to 66%. From 2013 to 2023, there was a steady decline in periprocedural complications including severe bleeding of VARC types 3 and 4 (8.5% to 2.9%), vascular complications (17.2% to 4.9%), stroke (4.2% to 2.1%), and pacemaker implantations (15.5% to 11.4%). Over the same period, the risk-adjusted 30-day mortality fell from 3.8% to 3.2%. The improved short-term results of TAVI from 2013 to 2023 are attributable to a change in patients' risk profiles as well as the increasing experience of the interventionists and refinements of the procedure. The mortality rate, which has remained unchanged in recent years, indicates that the care of older patients with severe aortic stenosis has been largely optimized.