Transcatheter aortic valve implantation for severe aortic stenosis in the Australian regional population

Abstract

Objective: To compare clinical and functional outcomes of regional and urban patients after transcatheter aortic valve implantation for severe aortic stenosis. Methods: Data were collected at patient follow-up post-transcatheter aortic valve implantation at 30 days and 12 months. Patients were stratified by residential postcodes into remoteness areas using the Australian Statistical Geography Standard. Design: Retrospective cohort study.Setting: Single-centre tertiary referral hospital.Participants: Patients undergoing transcatheter aortic valve implantation (n = 142) from 2009 to 2018 were analysed, with 77 patients (54.2%) residing in regional Victoria and New South Wales. Main outcome measures: Procedural success, adverse event rates, readmission rates, mortality rates, loss to follow-up and functional improvement. Results: Patients residing in regional areas had a lower mean age (81.8 vs 83.7 years) and proportion of Stage 4 or 5 chronic kidney disease (1.3% vs 9.2%), compared with urban patients. Procedural characteristics and immediate post-procedural outcomes were similar between both groups. There was no statistically significant difference in mortality, readmission rates or loss to follow-up between the two cohorts. Regional patients demonstrated poorer rates of functional improvement at 30 days (50.7% vs 67.7%); however, this difference was not sustained at 12 months (79.2% vs 71.0%). Frailty was demonstrated to be an independent predictor of poor 30-day functional improvement. Conclusion: Regional patients treated with transcatheter aortic valve implantation for severe aortic stenosis have non-inferior 30-day and 12-month outcomes, when compared with urban patients. Frailty is a predictor of poor functional improvement post-transcatheter aortic valve implantation. K E Y W O R D Scardiovascular medicine, health systems, models of regional service delivery, rural population health, therapeutics How to cite this article: Paleri S, Tham JL-M, Jin D, et al. Transcatheter aortic valve implantation for severe aortic stenosis in the Australian regional population.

Quality of life in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: tools and evidence

“…Mok et al 99 identified a decreased distance in the 6-min walking test (6MWT – with a cut-off distance of less than 170 m) as a predictor of futility in patients undergoing TAVI. Paleri et al 100 used the Clinical Frailty Scale (CFS) to assess frailty and when associated with the functional NYHA class found that frailty was a marker for absence of functional improvement. In another study conducted by Yoshijima et al 101 CFS proved to be predictive of poor symptomatic benefit at 1 year after TAVI.…”

Trends in Transcatheter Aortic Valve Implantation in Australia

“…A single-centre study of 142 patients consisting of 54% from regional Australia and 13% from outer regional Australia found no differences in procedural success and 30-day or 12-month mortality rates between regional and urban patients. [ 29 ] Importantly, these were regional patients who had to travel to a tertiary referral hospital to undergo their procedure.…”