Temporal trends of TAVI waiting times in a tertiary centre: from initial implementation to contemporary practice
G Zaburaite, V Bajoras, G DavidaviciusAbstract
Background
Over the past decades transcatheter aortic valve implantation (TAVI) has become an inevitable part of standard care of patients with severe aortic stenosis. With ageing population and expansion of TAVI applicability, waiting duration becomes of particular importance, as the natural course of the disease carries a poor prognosis without a timely definitive intervention.
Purpose
To assess how TAVI waiting times changed between 2009 and 2024 in a tertiary centre during a period of evolving practice.
Methods
A retrospective analysis of TAVI patient medical records during 2009 – 2024 was performed. Inclusion criteria were: i) confirmed diagnosis of severe aortic valve stenosis; ii) clear data points for the outcome variables. Primary outcome variable was total waiting time, starting with the date of the visit when indication for valve replacement was documented. Secondary outcomes were evaluation waiting time (from indication to the last pre-TAVI evaluation test) and procedural waiting time (from the last test to TAVI). Most recent cases during 2021 – 2024 were included in inferential analyses, for which only non-parametric tests were appropriate.
Results
Out of 866 TAVIs performed in the centre, 806 cases made up the final sample, of which 64.89 % were female and 85.36 % were 75 years or older. The total waiting time was a median of 237.5 (121.25; 501.75) days in 2009 – 2020 and a median of 173 (93; 310) days in 2021 – 2024. In 2021 – 2024, total waiting time differed significantly (p = 0.045), particularly between 2022 (153 days) and 2024 (238 days) (p = 0.046). Since 2021, procedural waiting time surpassed evaluation waiting time, at 70 and 66 days, respectively, and continued to increase (Figure 1), rising to 148 days in 2024 (p < 0.001). On the contrary, evaluation waiting time declined (p = 0.037) from 66 days in 2021 to 41 days in 2022. In 2024, the rates of chronic kidney disease (49.6 %, n = 62, p = 0.034), dyslipidemia (96 %, n = 120, p = 0.002) and peripheral arterial disease (22.4 %, n = 18, p = 0.018) were significantly higher, compared to earlier years. Proportion of NYHA III class patients in 2024 increased as well (77.6 %, n = 97, p = 0.002). No significant differences in the prevalence of left ventricular ejection fraction groups, atrial fibrillation, diabetes and other comorbidities, sex, age, place of residence were observed during 2021-2024.
Conclusions
Despite the increase in cumulative TAVI volume and established pathways, waiting times remain excessive for many patients and in recent years showed an increasing trend, driven by prolonged procedural waiting. Chronic kidney disease, dyslipidemia, NYHA III class, peripheral artery disease were more common in those who underwent TAVI in 2024. It remains ambiguous if higher comorbidity prevalence could be causally linked to longer waiting.Fig 1.Waiting times and cumulative volume.