Trends and Outcomes of Transcatheter Aortic Valve Implantation (TAVI) in Korea: the Results of the First Cohort of Korean TAVI Registry

Abstract

Background and ObjectivesThere has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea.MethodsThe first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years.ResultsMost of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p<0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p<0.001).ConclusionsK-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.

Comparing the Procedural and Clinical Outcomes of Sapien XT and Sapien 3 Valves in Transcatheter Aortic Valve Replacement in Korean Patients

“… 1) 2) 3) 4) 5) 6) In Korea, the TAVR procedure is poorly reimbursed by national insurance; regardless, the number of TAVR procedures is on the constant rise. 7) The latest version of the balloon-expandable TAVR valve, or Sapien 3 (S3) transcatheter heart valve (THV), became available in Korea in 2014. The S3 valve is now widely used in most Korean TAVR centers.…”

Transcatheter aortic valve replacement in patients with previous mitral valve replacement. A systematic study

“…Although TAVI patients with a history of any previous cardiac surgery constitute up to 30% of all TAVI patients, the large national registries [2][3][4][5] surprisingly do not specifically mention post-MVR patients. Probably the first report of TAVI (via the apical approach) in a patient with previous MVR was reported in 2008 [6], followed by one large Spanish registry of 91 patients [7], small series [8][9][10][11][12][13] and single cases [14][15][16][17][18][19][20] (for literature overview see Table I).…”

Moderate Aortic Valve Stenosis with Left Ventricular Systolic Dysfunction: Potential Role of Early Aortic Valve Replacement

“…Given the high rates of periprocedural death or stroke with surgical AVR especially in the patients with LVSD, the use of transcatheter AVR can be justified as a less invasive alternative approach in those patients with high surgical risk. 8) 9) The upcoming TAVR UNLOAD (Transcatheter Aortic Valve Replacement to Unload the Left ventricle in Patients with Advanced Heart Failure) trial (NCT02661451) 10) will provides more clear evidence whether early AVR improves clinical outcome in patients with moderate AS and LVSD.…”