Ten-year experience with transcatheter and surgical aortic valve replacement in Finland

Abstract

Aim: We investigated the outcomes of transcatheter (TAVR) and surgical aortic valve replacement (SAVR) in Finland during the last decade. Methods: The nationwide FinnValve registry included data from 6463 patients who underwent TAVR or SAVR with a bioprosthesis for aortic stenosis from 2008 to 2017. Results: The annual number of treated patients increased threefold during the study period. Thirty-day mortality declined from 4.8% to 1.2% for TAVR (p ¼ .011) and from 4.1% to 1.8% for SAVR (p ¼ .048). Two-year survival improved from 71.4% to 83.9% for TAVR (p < .001) and from 87.2% to 91.6% for SAVR (p ¼ .006). During the study period, a significant reduction in moderate-to-severe paravalvular regurgitation was observed among TAVR patients and a reduction of the rate of acute kidney injury was observed among both SAVR and TAVR patients. Similarly, the rate of red blood cell transfusion and severe bleeding decreased significantly among SAVR and TAVR patients. Hospital stay declined from 10.4 ± 8.4 to 3.7 ± 3.4 days after TAVR (p < .001) and from 9.0 ± 5.9 to 7.8 ± 5.1 days after SAVR (p < .001). Conclusions: In Finland, the introduction of TAVR has led to an increase in the invasive treatment of severe aortic stenosis, which was accompanied by improved early outcomes after both SAVR and TAVR. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT03385915 KEY MESSAGES This study demonstrated that the introduction of transcatheter aortic valve replacement has led to its widespread use as an invasive treatment for severe aortic stenosis. Early and 2-year survival after transcatheter and surgical aortic valve replacement has improved during past decade. Transcatheter aortic valve replacement has fulfilled its previously unmet clinical needs and has surpassed surgical aortic valve replacement as the most common invasive treatment for aortic stenosis.

Blood Transfusion and Outcome After Transfemoral Transcatheter Aortic Valve Replacement

“…The inclusion criteria for this study were (1) transfemoral TAVR for AS with or without aortic valve regurgitation; (2) patients aged >18 years; and (3) primary TAVR with or without concomitant coronary revascularization. The exclusion criteria were (1) prior TAVR or surgical intervention on the aortic valve; (2) transcatheter or surgical procedure for isolated aortic valve regurgitation; (3) acute endocarditis; and (4) TAVR performed through other than transfemoral access.…”

“…RECENT STUDIES FROM nationwide registries reported a three-to six-fold increase in the use of transcatheter aortic valve replacement (TAVR) procedures for severe aortic stenosis (AS) in previous years. 1,2 The widespread use of TAVR paralleled with a larger number of patients being referred for invasive treatment of AS with a documented improvement of early and midterm survival. 2 Interestingly, these studies showed a significant decrease in the rates of red blood cell (RBC) transfusion after TAVR during the most recent years.…”

“…1,2 The widespread use of TAVR paralleled with a larger number of patients being referred for invasive treatment of AS with a documented improvement of early and midterm survival. 2 Interestingly, these studies showed a significant decrease in the rates of red blood cell (RBC) transfusion after TAVR during the most recent years. [1][2][3] Still, a few previous studies [4][5][6][7][8] documented a high frequency of RBC transfusion after TAVR with a negative impact on the outcome.…”

“…2 Interestingly, these studies showed a significant decrease in the rates of red blood cell (RBC) transfusion after TAVR during the most recent years. [1][2][3] Still, a few previous studies [4][5][6][7][8] documented a high frequency of RBC transfusion after TAVR with a negative impact on the outcome. However, most of these studies were institutional series of limited size with short follow-up and without a thorough analysis of important bleeding-related variables, such as the amount of RBC transfusions, need of operation to treat severe bleeding, or drop of hemoglobin level.…”

Subtype of atrial fibrillation and the outcome of transcatheter aortic valve replacement: The FinnValve Study

“…The FinnValve registry is a Finnish multicenter nationwide registry including retrospectively collected data from consecutive patients undergoing TAVR or surgical aortic valve replacement with a bioprosthesis for severe AS at all five Finnish university hospitals (Turku, Helsinki, Kuopio, Tampere and Oulu) between January 2008 and November 2017 (Clinical trial registration: ClinicalTrials.gov Identifier: NCT03385915) [12]. The study protocol was approved by the Institutional Review Boards of all participating centers and the Ethics Committee of the National Institute for Health and Welfare.…”