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What is the impact of providing a transcatheter aortic valve implantation service on conventional aortic valve surgical activity: patient risk factors and outcomes in the first 2 years
  1. S W Grant,
  2. M P Devbhandari,
  3. A D Grayson,
  4. I Dimarakis,
  5. I Kadir,
  6. D M T Saravanan,
  7. R D Levy,
  8. S G Ray,
  9. B Bridgewater
  1. University Hospital of South Manchester, Manchester, UK
  1. Correspondence to Dr Ben Bridgewater, University Hospital of South Manchester NHS Foundation Trust, Southmoor Road, Manchester M23 9LT, UK; ben.bridgewater{at}uhsm.nhs.uk

Abstract

Objectives To assess the impact of introducing a transcatheter aortic valve implantation (TAVI) service on aortic valve surgical activity and outcomes.

Design A retrospective analysis of prospectively collected data.

Setting University hospital of south Manchester.

Patients 815 consecutive patients undergoing isolated aortic valve replacement (AVR) or coronary artery bypass grafting plus AVR from January 2006 to December 2009. Fifty consecutive patients who underwent TAVI from January 2008 to December 2009.

Main outcome measures Aortic valve surgical activity in the 2 years before the introduction of a TAVI service and in the 2 years following. Outcomes following conventional aortic valve surgery and TAVI.

Results In the 2 years following the introduction of TAVI at this centre, conventional AVR activity has increased by 37% compared with an 8% increase nationally (p<0.001). Compared with the 2 years before TAVI there was no change in the mean logistic EuroSCORE (7.4 vs 7.9 p=0.16) or crude mortality rate (2.9% vs 2.1% p=0.48). Fifty high-risk patients underwent TAVI with a 30-day mortality rate of 0%. The mean logistic EuroSCORE of the TAVI patients was 25.3.

Conclusions TAVI is an emerging alternative to AVR in high-risk patients. Since the introduction of a TAVI service at this centre, conventional AVR activity has increased. Despite a trend of increasing mean logistic EuroSCORE indicating that more complex cases are being undertaken, there has been a non-significant reduction in the crude mortality rate. Offering a TAVI service has a positive impact on the volume of conventional AVR surgical activity.

  • Aortic valve disease
  • aortic valve replacement
  • surgical activity
  • surgery valve
  • TAVI

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Footnotes

  • Linked articles 208983.

  • Competing interests BB is chairman of the SCTS database committee. He has received financial support for educational meetings and honoraria for speaking from various manufacturers of cardiac valves. RDL is a proctor and educator for Medtronic CoreValve and SGR has spoken at academic meetings organised by Medtronic CoreValve.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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