TAVR Procedural Volumes and Patient Outcomes: Analysis of Recent Data

Update on Transcatheter Aortic Valve Replacement

“…Institutionally, a case volume of [ 50 per year is suggested to achieve optimal outcomes [12]. However, data suggest that centers with higher procedural volumes on average experience better outcomes as measured by mortality even when excluding this learning period [17,18].…”

“…While TAVR does offer advantages over SAVR, some well-described adverse outcomes have been reported. The most pertinent procedural complications include paravalvular regurgitation and conduction disturbances including left bundle branch block or high-degree atrioventricular block requiring pacemaker [17,33,34]. These metrics in particular have improved over time but remain inferior to those of SAVR.…”

“…Conduction disturbances after TAVR have potential morbidity and mortality. This complication is likely the result of the close proximity between the conduction system and the aortic annulus [17,33,34]. However, data quantifying the rate of this complication are likely obsolete, as they include previous generations of devices.…”

“…Reported rates of this complication have a wide distribution, which is likely due to the heterogeneity of the procedure [33]. Self-expanding valves have been shown to carry a higher risk than balloon-expanding devices [17,33,34]. The majority of high-degree atrioventricular block occurs within 24 h of implantation, but this complication can develop [ 48 h afterwards [33].…”

The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2019

“…The indications for TAVR continue to evolve beyond severe aortic stenosis, as procedural volume and outcomes continue to improve. 14,15 In the setting of bicuspid aortic valve stenosis, a recent large registry analysis analyzed 5382 propensitymatched patients with primary endpoints defined as all-cause mortality at 30 days and at 1 year. 15 The risk of mortality was similar in both groups at 30 days (hazard ratio 1.04; 95% confidence interval 0.74-1.47) and at 1 year (hazard ratio 0.9; 95% confidence interval 0.73-1.10).…”