Temporal trends in procedural death and need for urgent open surgery during transcatheter aortic valve replacement: A single, high-volume center 10-year experience

Background: Despite advancements in the safety of transcatheter aortic valve replacement (TAVR) resulting in progressively wider indications, adverse periprocedural outcomes still raise concern. Real-world outcome data are thus of primary importance to evaluate the procedural risk-benefit trade-off in the continuously changing populations undergoing TAVR. Methods: We retrospectively assessed 1348 consecutive patients undergoing TAVR between 2007 and 2017. The primary endpoint was a composite of procedural mortality and need for conversion to emergent surgery, as defined by the Valve Academic Research Consortium-2 criteria. Temporal trends in baseline characteristics and outcomes were evaluated. The independent outcomes predictors were assessed through multivariate regression analysis. Results: A total of 56 (4.1%) patients experienced the primary endpoint. 47 (3.5%) patients died during hospital stay, 19 (1.4%) within 72 h from the procedure. 17 patients (1.2%) needed an emergent conversion to open surgery, of whom 7 (41.2%) did not survive. Significant temporal trends of increasing mean age (from 79.4 ± 7.4 to 81 ± 7.5, p = 0.007) and decreasing surgical risk (mean STS: from 9 ± 9.5 to 7.1 ± 9.8, p = 0.010) were observed. When dichotomized at the median procedural date (year 2014), a significant reduction in the occurrence of the primary endpoint in more recent years was observed (3.0% vs 5.2%, p = 0.041). This was the single primary endpoint independent predictor at multivariate analysis. Conclusion: The high-volume 10-year experience in TAVR procedures at our center shows encouraging trends in procedural mortality reduction, which anyhow still occurs at a non-negligible rate, calling for further research to detect and to blunt the determinant of early procedural events.