The development and structured evaluation of the TAVI program between 2016 and 2022

Abstract

Introduction: Due to the worldwide rising incidence of calcified aortic stenosis (AS) and the increasing need for Transcatheter Aortic Valve Implantation (TAVI), we analyzed the structural, organizational, and procedural evolution of TAVI implantations from 2016 to 2022. The aim of this study was to assess waiting times, patient characteristics and pre-existing comorbidities, while providing insights into factors that predict the outcome after TAVI. Additionally, this study examines changes in echocardiographic parameters before and after the intervention and investigates TAVI-associated complications. Methods: This retrospective study analyzed 1090 patients who received TAVI between 2016 and 2022 at the Division of Cardiology at the Medical University Hospital of Graz. Patient individual characteristics, echocardiographic parameters, intra-procedural information, and follow-up data up to 360 days after the procedure were collected and analyzed. In addition, waiting times for TAVI and the duration of post-procedural hospitalization duration were obtained and statistically evaluated. Results: Our analysis revealed significant post-procedural improvements in left ventricular ejection fraction (LVEF) for patients with pre-procedural LVEF values between 0-30% and 31-50%. Mean aortic pressure gradient (MPG) also significantly decreased from a pre-procedural average of 46 mmHg to a post-procedural average of 8.6 mmHg. Although, waiting times to receive TAVI decreased progressively from 2016 to 2019, they significantly increased during the COVID-19 pandemic from 2020 to 2022. Additionally, the average post-TAVI hospitalization duration decreased from 9.7 ± 7 days in 2016 to 7.3 ± 4.6 in 2022. Moreover, no significant association was found between an increased rate of permanent pacemaker (PPM) implantation and the use of either self- or balloon-expanding valves or pre- or post-implantation aortic valve dilation. While 30-, 90-, and 360-day survival rates gradually improved from 95.7%, 95.0% and 93.5% in 2016 to 97.3%, 95.8% and 93.2% in 2022, but no statistically significant differences were identified. This study also noted a significant association between increased mortality rates in patients with GFR < 30 ml/min/1.73m2, sPAP > 51 mmHG, MPG ≤ 30 mmHg or LVEF ≤ 40%. Conclusion: This study demonstrates a notable reduction in post-TAVI hospitalization duration over the last years and a significant increase in waiting times to receive during the COVID-19 pandemic. It underscores the impact of comorbidities, and specific echocardiographic parameters on patient outcomes and survival after TAVI. Finally, this study highlights the importance of individual decision-making prior to every TAVI procedure and identifies a positive trend in TAVI procedures over the past seven years.

Datum der Bewilligung	2025
Originalsprache	Englisch
Gradverleihende Hochschule	Medizinische Universität Graz
Betreuer/-in	Gabor Toth-Gayor (Betreuer*in) & Albrecht Schmidt (Mitbetreuer*in)