Longitudinal trends and outcomes in transcatheter aortic valve implantation: a report from the Swiss TAVI registry
T Stolte, J J Reichl, D Tueller, F Goetzinger, M Wagener, S Stortecky, R Jeger, S Toggweiler, E Ferrari, P Wenaweser, C Huber, S Windecker, F Mahfoud, Stephane Noble, T NestelbergerAbstract
Background
The progressive expansion of indications for Transcatheter Aortic Valve Implantation (TAVI) towards lower-risk and younger populations has raised concerns about potential outcome attenuation with increasing procedural volumes. Real-world evidence addressing this concern is limited.
Objective
To assess longitudinal trends and changes in patient characteristics and procedural outcomes in a large nationwide TAVI cohort.
Methods
The SwissTAVI Registry prospectively enrolled consecutive patients undergoing TAVI in Switzerland. Baseline characteristics, procedural complications and outcomes were compared across three periods: 2011-2015, 2016-2020 and 2021-2024. The primary endpoint was major adverse cardiovascular events (MACE: all-cause mortality, non-fatal myocardial infarction, and non-fatal stroke) at one year. The secondary endpoint was 30-day MACE.
Results
Among 19’452 patients, TAVI volume increased 27% annually. Patient age (82 years) and comorbidity burden remained stable, while the proportion of women increased (51% to 58%) and the median STS score decreased (4.5% to 3.3%). Considering the expansion to lower-risk patients, 1-year MACE declined significantly from 16% to 14% to 9.1% across periods (adjusted HR 0.69, 95% CI 0.62-0.78, p<0.001). Similarly, 30-day MACE decreased from 6.9% to 5.2% to 4.0% (adjusted HR 0.66, 95%CI 0.55-0.78, p<0.001). Procedural mortality declined from 2.9% to 1.2%, periprocedural myocardial infarction from 0.4% to 0.2% and stroke from 3.2% to 2.0% (all p<0.001). (Figure 1).
Conclusion
Risk-adjusted TAVI outcomes improved continuously despite a significant volume increase, with improvements exceeding those expected from lower-risk patients risk profiles alone.For image description, please refer to the figure legend and surrounding text.