Impact Of TAVI Programme On Surgical AVR Workload In A Single Institution
Tom Combellack, Yasir Ahmed, Alex Chase, Dave Smith, Aprim Youhana, Pankaj Kumar.
Morriston Hospital, Swansea, United Kingdom.
OBJECTIVE: Aortic valve disease is underserved in the UK. Since the introduction of transcatheter aortic valve intervention (TAVI), many patients who were previously considered unfit for surgery by community physicians / cardiologists are now being referred to the Heart Valve Team (HVT) for intervention.
The aim of our study was to assess the impact of a TAVI programme, introduced in our institution in 2009, on the total number of aortic valve interventions and surgical aortic valve replacements (SAVR) for the population we serve.
METHODS: We performed a retrospective analysis of all aortic valve interventions from 2006-2015 (10 years) in our centre as recorded in the national database. In particular, we compared the most recent 3 years of the TAVI programme (2013-2015) to the 3 years preceding the TAVI programme (2006-2008), analysing the proportion of departmental activity, age (median, interquartile range (IQR)), logistic EuroSCORE (median, IQR) and re-sternotomy rate (%).
RESULTS: Of the 7337 procedures in the date range, we identified 2741 patients who underwent aortic valve intervention, of which 96% were SAVR and 4% were TAVI (see figure).
Comparing the most recent 3 years to the 3 years preceding the programme, there was an increase in mean annual aortic interventions from 219 (range 167-272) to 327 (range 265-367). As a proportion of all departmental activity, this represented an increase in aortic valve interventions from 27% to 48%, with a 19% increase in SAVR. Median age increased from 72 (IQR 65-78) to 75 (IQR 68-81), median logistic EuroSCORE increased from 7.15 (IQR 3.88 -13.15) to 7.67 (IQR 4.36-14.24) and re-sternotomy rate increased from 3.3% to 4%.CONCLUSIONS: The advent of TAVI and the HVT has ushered in a new era in aortic valve intervention. In our institution, the introduction of a TAVI programme has been very positive for our patients and has resulted in many more being considered for SAVR. Our experience would suggest that all patients with aortic valve disease should be referred to the HVT.
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