Impact of Transcatheter Aortic Valve Implantation on Surgical Aortic Valve Replacement activity: a single institution study

Introduction TAVI has gained popularity as a treatment option for severe symptomatic aortic stenosis in patients at high- and excessive operative risk. Recent evidence has also shown that TAVI is safe and effective in intermediate-risk patients. An important concern among the surgical community is that the expansion of TAVI will reduce overall surgical activity. Aim I aimed to assess the impact of TAVI on surgical aortic valve replacement (SAVR) activity in a single institution which was University Hospital Galway, Ireland. Methods I performed a retrospective analysis of SAVR at University Hospital Galway between October 2011 and November 2016 and TAVI since its introduction in May 2014. The number of procedures, patient demographics and comorbidities, echocardiographic data and clinical outcomes were recorded at 30-days. Results May 2014 to November 2016: 94 TAVI performed. median age 83.5 years, median Euroscore II 6%, 30-day mortality 2.1%, stroke 2.1%, NPOAF 1.06 %, PPM 21.28% , paravalvular leak graded moderate or above 11.6% , major vascular complication 3.19%, median PLOS 3 days. October 2011 to April 2014: (31 months prior to introduction of TAVI), 111 SAVR performed. Median age 71 years, median Euroscore II 2.18%, 30-day mortality 3.6%, resternotomy 2.7%, stroke 2.7%, NPOAF 34.23%, PPM 3.6%, no paravalvular leak graded moderate or above, median PLOS 10 days. Over the same 31 months as TAVI was being performed, 164 cases of SAVR were performed. In this period, median age was 70 years, median Euroscore II 2.01%, 30-day mortality 1.22%, resternotomy 4.88%, there were no strokes, NPOAF 38.41%, PPM 3.66%, paravalvular leak graded moderate or above 2.44%, median PLOS 9 days. Conclusion The introduction of TAVI in our institution did not reduce surgical activity. On the contrary, SAVR rates have increased in this time. TAVI has increased the overall aortic valve intervention in our institution by treating an additional cohort of patients.