Evolution of Procedural and Clinical Outcomes After Balloon-Expanding Transcatheter Aortic Valve Implantation In Canada (from the Early Canadian Experience and SOURCE XT Registries)

Rishi Puri, John G. Webb, Faisal Al Qoofi, Robert C. Welsh, Craig Brown, Jean Bernard Masson, Madhu K. Natarajan, Charles Peniston, Asim N. Cheema, Samuel Radhakrishnan, Philippe Genereux, Martin Thoenes, Mélanie Côté, Josep Rodés-Cabau

Research output: Contribution to journalArticle

Abstract

Transcatheter aortic valve implantation (TAVI) has evolved globally, yet its evolution and performance across the Canadian landscape have yet to be formally assessed. Patients captured within the early Canadian TAVI experience with a balloon-expanding valve (n = 339; 2005 to 2009) and those enrolled in the Canadian SOURCE XT registry (n = 415; 2012 to 2015) were systematically compared with respect to baseline clinical, echocardiographic, and procedural characteristics. Valve-related and clinical outcomes were compared across the 2 time periods according to standardized definitions. Notable baseline between-group differences were noted across time, with Society of Thoracic Surgeons Predicted Risk of Mortality score being lower in the SOURCE XT cohort compared with the earlier Canadian cohort (7.4 ± 6.6% vs 9.8 ± 6.4%, p <0.001). The SOURCE XT cohort underwent TAVI through the transfemoral approach more frequently than their earlier Canadian counterparts (75% vs 48%), at the expense of transapical access, with major access site vascular complications (2.7% vs 13%), and ≥mild residual aortic regurgitation (39% vs 69%) being significantly less frequent (p <0.001 for all). At 30-days, there were no significant differences in rates of stroke (1.9% vs 2.4%) or new pacemakers (5.8% vs 5.0%); however, 30-day and 1-year mortality rates were significantly lower in the SOURCE XT cohort (3.6% vs 10.4%; 13.0% vs 24.2%, respectively, p<0.001 for both). In conclusion, TAVIs evolution in Canada with a balloon-expanding valve coincided with more optimized patient selection and increasing use of transfemoral access, which along with increasing operator experience, contributed to improved procedural and longer term clinical outcomes.

Original languageEnglish (US)
Pages (from-to)461-467
Number of pages7
JournalAmerican Journal of Cardiology
Volume122
Issue number3
DOIs
StatePublished - Aug 1 2018

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Canada
Registries
Aortic Valve Insufficiency
Mortality
Patient Selection
Blood Vessels
Stroke
Transcatheter Aortic Valve Replacement

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Puri, Rishi ; Webb, John G. ; Al Qoofi, Faisal ; Welsh, Robert C. ; Brown, Craig ; Masson, Jean Bernard ; Natarajan, Madhu K. ; Peniston, Charles ; Cheema, Asim N. ; Radhakrishnan, Samuel ; Genereux, Philippe ; Thoenes, Martin ; Côté, Mélanie ; Rodés-Cabau, Josep. / Evolution of Procedural and Clinical Outcomes After Balloon-Expanding Transcatheter Aortic Valve Implantation In Canada (from the Early Canadian Experience and SOURCE XT Registries). In: American Journal of Cardiology. 2018 ; Vol. 122, No. 3. pp. 461-467.
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abstract = "Transcatheter aortic valve implantation (TAVI) has evolved globally, yet its evolution and performance across the Canadian landscape have yet to be formally assessed. Patients captured within the early Canadian TAVI experience with a balloon-expanding valve (n = 339; 2005 to 2009) and those enrolled in the Canadian SOURCE XT registry (n = 415; 2012 to 2015) were systematically compared with respect to baseline clinical, echocardiographic, and procedural characteristics. Valve-related and clinical outcomes were compared across the 2 time periods according to standardized definitions. Notable baseline between-group differences were noted across time, with Society of Thoracic Surgeons Predicted Risk of Mortality score being lower in the SOURCE XT cohort compared with the earlier Canadian cohort (7.4 ± 6.6{\%} vs 9.8 ± 6.4{\%}, p <0.001). The SOURCE XT cohort underwent TAVI through the transfemoral approach more frequently than their earlier Canadian counterparts (75{\%} vs 48{\%}), at the expense of transapical access, with major access site vascular complications (2.7{\%} vs 13{\%}), and ≥mild residual aortic regurgitation (39{\%} vs 69{\%}) being significantly less frequent (p <0.001 for all). At 30-days, there were no significant differences in rates of stroke (1.9{\%} vs 2.4{\%}) or new pacemakers (5.8{\%} vs 5.0{\%}); however, 30-day and 1-year mortality rates were significantly lower in the SOURCE XT cohort (3.6{\%} vs 10.4{\%}; 13.0{\%} vs 24.2{\%}, respectively, p<0.001 for both). In conclusion, TAVIs evolution in Canada with a balloon-expanding valve coincided with more optimized patient selection and increasing use of transfemoral access, which along with increasing operator experience, contributed to improved procedural and longer term clinical outcomes.",
author = "Rishi Puri and Webb, {John G.} and {Al Qoofi}, Faisal and Welsh, {Robert C.} and Craig Brown and Masson, {Jean Bernard} and Natarajan, {Madhu K.} and Charles Peniston and Cheema, {Asim N.} and Samuel Radhakrishnan and Philippe Genereux and Martin Thoenes and M{\'e}lanie C{\^o}t{\'e} and Josep Rod{\'e}s-Cabau",
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Puri, R, Webb, JG, Al Qoofi, F, Welsh, RC, Brown, C, Masson, JB, Natarajan, MK, Peniston, C, Cheema, AN, Radhakrishnan, S, Genereux, P, Thoenes, M, Côté, M & Rodés-Cabau, J 2018, 'Evolution of Procedural and Clinical Outcomes After Balloon-Expanding Transcatheter Aortic Valve Implantation In Canada (from the Early Canadian Experience and SOURCE XT Registries)', American Journal of Cardiology, vol. 122, no. 3, pp. 461-467. https://doi.org/10.1016/j.amjcard.2018.04.032

Evolution of Procedural and Clinical Outcomes After Balloon-Expanding Transcatheter Aortic Valve Implantation In Canada (from the Early Canadian Experience and SOURCE XT Registries). / Puri, Rishi; Webb, John G.; Al Qoofi, Faisal; Welsh, Robert C.; Brown, Craig; Masson, Jean Bernard; Natarajan, Madhu K.; Peniston, Charles; Cheema, Asim N.; Radhakrishnan, Samuel; Genereux, Philippe; Thoenes, Martin; Côté, Mélanie; Rodés-Cabau, Josep.

In: American Journal of Cardiology, Vol. 122, No. 3, 01.08.2018, p. 461-467.

Research output: Contribution to journalArticle

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AU - Al Qoofi, Faisal

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