Changes in instrumentation and procedures are the main driver of improvement in TAVR results

September 19, 2022

2 minutes to read

source:

Arnold SV et al. Late Clinical Science Session in Structural Cardiology: Session 4, in collaboration with Dr. Journal of the American College of Cardiology. Presented at: TCT Scientific Symposium; 16-19 September 2022; Boston (mixed meeting).

Disclosures:
Arnold does not report any relevant financial disclosures.


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BOSTON β€” Changes in instrumentation and procedural care have been the biggest factor in improvements in short-term outcomes for patients undergoing transcatheter aortic valve replacement, researchers reported at the TCT 2022 conference.

changes in the comorbidities of the patient, As TAVR becomes more widely available to lower-risk patients over timewas a major factor in the improvement in long-term mortality after TAVR, but Changes in hardware and procedural care It was also a factor, according to an analysis of the Society of Thoracic Surgeons/Transcatheter Valve Treatments Registry of the American College of Cardiology.

Susan F. Arnold

“We believe our findings underscore the importance of device iterations and non-device procedural factors for short-term mortality and complications of TAVR, and may have important implications for future device innovation, particularly as we move to the treatment of other forms of valvular heart disease,” Susan F. Arnold, MD, MHA, An assistant professor of medicine at the University of Missouri-Kansas City School of Medicine and a clinical scientist at the Central American Heart Institute in St. Luke’s, said in a press conference.

Arnold and colleagues analyzed 161,196 patients included in the TVT registry who underwent TAVR at 596 hospitals in the United States between 2011 and 2018 to determine how changes in patient risk and improved procedures might contribute to improved TAVR outcomes over time.

The researchers evaluated factors from five median groups: demographics, non-CV comorbidities, CV-comorbidities, organ factors, and non-organ procedural factors.

Outcomes of interest were 30-day and 1-year mortality and a composite of 30-day adverse events including death, stroke, acute kidney injury, hemorrhage, and paravalvular leakage.

From 2011 to 2018, the 30-day mortality decreased from 6.7% to 2.4%, the one-year mortality decreased from 19.9% ​​to 10.1% and the 30-day composite score decreased from 25.3% to 10.5%, the most recent decline driven by Death, bleeding and paravalvular leakage, Arnold said at the press conference.

Arnold said device and non-device procedural factors played the largest role in the improvement in 30-day mortality and the 30-day composite score over time, noting that before it was calculated, the OR was to see if the 30-day mortality rate was. The more or less likelihood of subsequent actions was 0.87 and the OR for the composite outcome was 0.84, after which it was calculated, the OR for the 30-day mortality was 1 and the OR for the composite outcome was 0.96, with the remaining 0.04 being explained by an operator learning curve.

In other words, device factors and non-device related procedural factors accounted for 70% of the improvement in the 30-day mortality and 67% of the improvement in the 30-day composite outcome, Arnold said.

In contrast, she said, system factors and non-systemic procedural factors accounted for 45% of the improvement in one-year mortality, about the same as for comorbidities with CV and non-CV.

“Although American patients are getting younger and healthier over time, it appears that changes in instrumentation and procedural care primarily lead to reductions in short-term outcomes,” Arnold said at the press conference. Whereas, changes in comorbidities are associated with a long-term decrease in mortality. The learning curve, or improvements in operator skill, is associated with reduced complications. There remains a strong association between organ changes, procedural factors, and long-term mortality, likely due to its association with short-term complications, which have an impact on long-term mortality.”

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