Transcatheter aortic valve implantation (TAVI) activity in Australia now exceeds that of surgical aortic valve replacement (SAVR) and is consistent with international best practice, despite its late start compared to Europe and the US.
A study, published in Heart, Lung and Circulation [link here], compared annual activity for the procedures between 1 July 2012 and 30 June 2022, noting that TAVI received regulatory approval here in 2013.
It found a total of 46,499 SAVR and 18,519 TAVI were performed in Australia during the 10-year study period.
The number of SAVRs decreased from 5,236 in 2012–13 to 3,870 in 2021–22 while the number of TAVIs performed each year increased from 0 in 2012–13 to 3,967 in 2021–22.
“Notably, annual TAVI activity exceeded annual SAVR activity for the first time in 2021–22,” the study said.
“If we assume the number of SAVR-eligible patients has not changed since 2012–13, this data suggests that the ratio of “TAVI in SAVR-eligible patients” to “TAVI in SAVR-ineligible patients” in 2021–22 was 1:2 (1,366 vs 2,601 procedures).”
However population-adjusted activity generated a ratio of 1:1 and age cohort-adjusted activity a ration of 2:1.
The study found the rate of change in SAVR and TAVI activity increased across the relevant age cohorts.
“It reveals that SAVR vs TAVI activity progressively shifted from predominantly SAVR in the 65–69 years of age cohort (85% vs 15%) to predominantly TAVI in the 85+ years of age cohort (5% vs 95%). The point of equipoise was the 75–79 years of cohort (50% vs 50%).”
The data also suggested that the key driver of the overall increase in TAVI activity has been in the 85+ years of age cohort, most of whom would have been SAVR-ineligible.
“It provides important data for clinicians counselling SAVR-eligible patients in the grey zone (ages 65–80 years) who are exploring the options of SAVR and TAVI through shared decision-making.”
“These patients should be informed that current practice in Australia results in a gradual transition from SAVR-dominance to TAVI-dominance, with the current point of equipoise being the 75–79 years of age cohort—which is consistent with international guidelines.”
Readmissions
Meanwhile, another Australian study published in Heart, Lung and Circulation [link here], has found that the 90-day readmission rate following TAVI is relatively high at 22.2%.
Most readmissions were potentially related to the hospital care during the index admission for TAVI (42.3%) while 26.5% were classified as cardiovascular conditions and 31.2% as other conditions.
The investigators said further efforts to improve patient selection, improve TAVI proceduralists’ skills, and optimise team-based approaches were warranted to minimise readmissions.
The study found 76% of the readmissions were to a different hospital than the index hospital.
Readmission to a non-index hospital was strongly associated with remoteness of patient’s residence (aOR for regional or remote areas vs major cities: 4.78), having pre-procedure hospital transfer (aOR 4.20), lower socio-economic status (aOR for most disadvantaged vs least disadvantaged: 3.32), and private index hospital (aOR 1.85).
“Finally, we observed no significant differences in readmission length of stay, 90-day mortality and 1-year mortality between index and non-index readmissions,” the authors wrote.
They concluded that: “…our findings of similar mortality between index and non-index readmission are reassuring and support the current “spoke-and-wheel” referral model, wherein high-volume facilities specialise in TAVI procedures and manage readmissions in conjunction with regional referral hospitals.”