Annual Outcomes From the STS/ACC TVT Registry Evaluate Transcatheter Valve Therapy

November 30, 2015—David R. Holmes, Jr, MD, et al published a report of the annual outcomes of transcatheter valve therapy (TVT) from the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) TVT Registry, which is available online ahead of print in Annals of Thoracic Surgery and Journal of the American College of Cardiology.

In an accompanying editorial, “Watching a Procedure Evolve Sequential Findings From the TVT Registry,” Michael J. Reardon, MD, and Neal S. Kleiman, MD, discuss the implications of the registry findings. This editorial is also available online ahead of print in Annals of Thoracic Surgery and Journal of the American College of Cardiology.

The report provides an overview on current TVT practice and trends in the United States. The emphasis is on demographics, in-hospital procedural characteristics, and outcomes of patients having transcatheter aortic valve replacement (TAVR) performed at 348 centers in the United States. The TVT Registry captured 26,414 TAVR procedures as of December 31, 2014. The investigators compared temporal trends between 2012 and 2013 versus 2014.

As summarized in the study, a comparison of the two time periods reveals that TAVR patients remain elderly (mean age, 82 years); have multiple comorbidities, reflected by a high mean STS predicted risk of mortality for surgical valve replacement (8.34%); were highly symptomatic (New York Heart Association functional class 3/4 in 82.5%); frail (slow 5-minute walk test in 81.6%); and had poor self-reported health status (median baseline Kansas City Cardiomyopathy Questionnaire score of 39.1). 

Procedure performance is changing, with an increased use of moderate sedation (from 1.6% to 5.1%) and an increase in femoral access using percutaneous techniques (66.8% in 2014). Vascular complication rates are decreasing (from 5.6% to 4.2%), whereas site-reported stroke rates remain stable at 2.2%, 

The investigators concluded that the TVT Registry provides important information on characteristics and outcomes of TAVR in contemporary clinical practice in the United States, and it can be used to identify trends in practice and opportunities for quality improvement.