Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI Pathway Registry

Liesbeth Rosseel; Darren Mylotte; Bernard Cosyns; Maarten Vanhaverbeke; David Zweiker; Rui Campante Teles; Oskar Angerås; Antoinette Neylon; Tanja Katharina Rudolph; Joanna J Wykrzykowska; Tiffany Patterson; Giulia Costa; Soledad Ojeda; Apostolos Tzikas; Marcel Abras; Lionel Leroux; Eric Van Belle; Didier Tchétché; Sabine Bleiziffer; Martin J Swaans; Radoslaw Parma; Daniel J Blackman; Nicolas M Van Mieghem; Marek Grygier; Simon Redwood; Bernard Prendergast; Guy Van Camp; Ole De Backer

doi:10.3389/fcvm.2023.1227217

Contemporary European practice in transcatheter aortic valve implantation: results from the 2022 European TAVI Pathway Registry

Front Cardiovasc Med. 2023 Aug 14:10:1227217. doi: 10.3389/fcvm.2023.1227217. eCollection 2023.

Authors

Liesbeth Rosseel^{1

2}, Darren Mylotte³, Bernard Cosyns^{2

4}, Maarten Vanhaverbeke⁵, David Zweiker⁶, Rui Campante Teles^{7

8}, Oskar Angerås^{9

10}, Antoinette Neylon¹¹, Tanja Katharina Rudolph¹², Joanna J Wykrzykowska¹³, Tiffany Patterson¹⁴, Giulia Costa¹⁵, Soledad Ojeda¹⁶, Apostolos Tzikas¹⁷, Marcel Abras¹⁸, Lionel Leroux¹⁹, Eric Van Belle²⁰, Didier Tchétché²¹, Sabine Bleiziffer²², Martin J Swaans²³, Radoslaw Parma²⁴, Daniel J Blackman²⁵, Nicolas M Van Mieghem²⁶, Marek Grygier²⁷, Simon Redwood¹⁴, Bernard Prendergast¹⁴, Guy Van Camp²⁸, Ole De Backer²⁹

Affiliations

¹ Department of Cardiology, Algemeen Stedelijk Hospital, Aalst, Belgium.
² Faculteit Geneeskunde, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
³ Department of Cardiology, University Hospital Galway and National University of Ireland, Galway, Ireland.
⁴ Centrum Voor Hart- en Vaatziekten (CHVZ), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
⁵ Department of Cardiology, AZ Delta, Roeselare, Belgium.
⁶ Division of Cardiology, Department of Cardiology and Intensive Care, Clinic Ottakring, Medical University of Graz, Graz, Austria.
⁷ Centro Hospitalar de Lisboa Ocidental (CHLO), Hospital de Santa Cruz.
⁸ Nova Medical School, Centro de Estudo de Doenças Crónicas (CEDOC), Lisbon, Portugal.
⁹ Department of Cardiology, Sahlgrenska University Hospital, Gothenberg, Sweden.
¹⁰ Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
¹¹ Institut Cardiovasculaire Paris Sud, Ramsay Santé, Massy, France.
¹² Clinic of General and Interventional Cardiology, Heart and Diabetes Center Nordrhine Westfalia, Ruhr-University, Bad Oeynhausen, Germany.
¹³ Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands.
¹⁴ Department of Cardiology, Guys and St Thomas' NHS Foundation Trust London, London, United Kingdom.
¹⁵ Cardiac Catheterization Division, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
¹⁶ Division of Interventional Cardiology, Reina Sofia Hospital, Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIV), University of Córdoba, Córdoba, Spain.
¹⁷ Department of Cardiology, European Interbalkan Medical Centre, Thessaloniki, Greece.
¹⁸ University Clinic of Interventional Cardiology, Nicolae Testemitanu State University of Medicine and Pharmacy from Republic of Moldova, Chişinău, Moldova.
¹⁹ Medico-Surgical Department of Valvulopathies, CHU De Bordaux, Pessac, France.
²⁰ CHU Lille, Institut Cœur Poumon, Pôle Cardiovasculaire et Pulmonaire, ACTION Group, Inserm U1011, Institut Pasteur de Lille, EGID, Université de Lille, Lille, France.
²¹ Department of Interventional Cardiology, Clinique Pasteur, Toulouse, France.
²² Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany.
²³ Department of Cardiology, St. Antonius Hospital, Nieuwegein, Netherlands.
²⁴ Department of Cardiology and Structural Heart Diseases, 3 Division of Cardiology, Medical University of Silesia, Katowice, Poland.
²⁵ Department of Cardiology, Leeds Teaching Hospitals, Leeds, United Kingdom.
²⁶ Department of Interventional Cardiology, Erasmus University Medical Center, Rotterdam, Netherlands.
²⁷ Chair and 1st Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
²⁸ Department of Cardiology, Heart Center OLV Aalst, Aalst, Belgium.
²⁹ Heart Center, Rigshospitalet, Copenhagen, Denmark.

Abstract

Background: A steep rise in the use of transcatheter aortic valve implantation (TAVI) for the management of symptomatic severe aortic stenosis occurred. Minimalist TAVI procedures and streamlined patient pathways within experienced Heart Valve Centres are designed to overcome the challenges of ever-increasing procedural volume.

Aims: The 2022 European TAVI Pathway Survey aims to describe contemporary TAVI practice across Europe.

Materials and methods: Between October and December 2022, TAVI operators from 32 European countries were invited to complete an online questionnaire regarding their current practice.

Results: Responses were available from 147 TAVI centres in 26 countries. In 2021, the participating centres performed a total number of 27,223 TAVI procedures, with a mean of 185 TAVI cases per centre (median 138; IQR 77-194). Treatment strategies are usually (87%) discussed at a dedicated Heart Team meeting. Transfemoral TAVI is performed with local anaesthesia only (33%), with associated conscious sedation (60%), or under general anaesthesia (7%). Primary vascular access is percutaneous transfemoral (99%) with secondary radial access (52%). After uncomplicated TAVI, patients are transferred to a high-, medium-, or low-care unit in 28%, 52%, and 20% of cases, respectively. Time to discharge is day 1 (12%), day 2 (31%), day 3 (29%), or day 4 or more (28%).

Conclusion: Reported adoption of minimalist TAVI techniques is common among European TAVI centres, but rates of next-day discharge remain low. This survey highlights the significant progress made in refining TAVI treatment and pathways in recent years and identifies possible areas for further improvement.

Keywords: Transcatheter aortic valve implantation; aortic stenosis; early discharge; minimalist TAVI; multidisciplinary Heart Team.

© 2023 Rosseel, Mylotte, Cosyns, Vanhaverbeke, Zweiker, Teles, Angerås, Neylon, Rudolph, Wykrzykowska, Patterson, Costa, Ojeda, Tzikas, Abras, Leroux, Van Belle, Tchétché, Bleiziffer, Swaans, Parma, Blackman, Van Mieghem, Grygier, Redwood, Prendergast, Van Camp and De Backer.