STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement

Rescue valve‐in‐valve TAVI: Buy one get one free!

“…The investigators are to be congratulated on their elegant report, which is a welcome addition to the existing literature. This analysis from Japan complements a plethora of prior investigations, including a notable report from the ACC‐STS TVT registry, 2 which showed that the need for immediate/urgent THV‐in‐THV declined between 2011 and 2019. This was observed in contradistinction to the annual volume of elective/planned THV‐in‐THV procedures—predominantly performed for surgical bioprosthetic valve degeneration—which increased over time, 2 commensurate with the progressive increase in the overall number of TAVI procedures (which is expected to exceed 300,000 per year by 2025).…”

“…Carroll et al reported TAVI outcomes in the United States between 2011 and 2019 from the American College of Cardiology‐Society of Thoracic Surgeons Transcatheter Valve Therapy (ACC‐STS TVT) registry 2 . They included data on 276,316 patients who underwent TAVI at 49 sites, and showed a reduction in 30‐day mortality from 7.2 to 2.5% and a slight decrease in stroke rates (2.75% to 2.3%) 2 . In 2018, 81% of patients who underwent TAVI were alive and with acceptable patient‐reported outcomes at 1 year 2 .…”

“…They included data on 276,316 patients who underwent TAVI at 49 sites, and showed a reduction in 30‐day mortality from 7.2 to 2.5% and a slight decrease in stroke rates (2.75% to 2.3%) 2 . In 2018, 81% of patients who underwent TAVI were alive and with acceptable patient‐reported outcomes at 1 year 2 . Nevertheless, several TAVI procedural complications—albeit infrequent—still occur and are associated with dreadful consequences.…”

Reply: Boomer or barometer?

“…In slightly more than 1000 consecutive cases, we did 2 direct aortic and 0 transapical cases, with 98% being transfemoral (TF) and the rest split between trans-axillary and TC. Indeed, the recent publication of the US Transcatheter Valve Therapy Registry data by Carroll and colleagues 6 showed that during 2019 the TF rate was 95.3% and that TTh access has approached 0. The TAVR field has advanced so rapidly that it is imperative to use contemporary data when making decisions for our patients.…”

Transcarotid: A sign from above?

“…With the expansion of transcatheter aortic valve replacement (TAVR), implanting centers with variable experience and skill level will need to make some choices. Currently, only 4.7% cases utilize nontransfemoral access and the median number of nontransfemoral procedures is four cases 1,2 . As last measure, 662 TC TAVR were performed in the United States amongst 72,991 TAVR procedures, making TC access a niche procedure.…”