Comparative Survival After Transapical, Direct Aortic, and Subclavian Transcatheter Aortic Valve Implantation (Data from the UK TAVI Registry)

ObjectiveThis cross-sectional observational study sought to describe variations in CT in the context of transcatheter aortic valve implantation (CT-TAVI) as currently performed in the UK.Methods408 members of the British Society of Cardiovascular Imaging were invited to complete a 27-item online CT-TAVI survey.Results47 responses (12% response rate) were received from 40 cardiac centres, 23 (58%) of which performed TAVI on-site (TAVI centres). Only six respondents (13%) performed high-volume activity (>200 scans per year) compared with 13 (28%) performing moderate (100–200 scans per year) and 27 (59%) performing low (0–99 scans per year) volume activity. Acquisition protocols varied (41% retrospective, 12% prospective with wide padding, 47% prospective with narrow padding), as did the phase of reporting (45% systolic, 37% diastolic, 11% both, 6% unreported). Median dose length product was 675 mGy.cm (IQR 477–954 mGy.cm). Compared with non-TAVI centres, TAVI centres were more likely to report minimum iliofemoral luminal diameter (n=25, 96% vs n=7, 58%, p=0.003) and optimal tube angulation for intervention (n=12, 46% vs n=1, 8%, p=0.02).ConclusionsThis national survey formally describes current CT-TAVI practice in the UK. High-volume activity was only present at one in seven cardiac CT centres. There is wide variation in scan acquisition, scan reporting and radiation dose exposure in cardiac CT centres.

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Comparing post-operative resource consumption following transcatheter aortic valve implantation (TAVI) and conventional aortic valve replacement in the UK

Journal of Medical Economics ◽

10.3111/13696998.2014.904322 ◽

2014 ◽

Vol 17 (5) ◽

pp. 357-364 ◽

Cited By ~ 8

Author(s):

W. Awad ◽

A. Mathur ◽

L. Baldock ◽

S. Oliver ◽

S. Kennon

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Implantation ◽

Resource Consumption ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

The Uk ◽

Valve Implantation

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Influence of Gender on Clinical Outcomes Following Transcatheter Aortic Valve Implantation from the UK Transcatheter Aortic Valve Implantation Registry and the National Institute for Cardiovascular Outcomes Research

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.10.024 ◽

2014 ◽

Vol 113 (3) ◽

pp. 522-528 ◽

Cited By ~ 30

Author(s):

Rasha Al-Lamee ◽

Christopher Broyd ◽

Jessica Parker ◽

Justin E. Davies ◽

Jamil Mayet ◽

...

Keyword(s):

Aortic Valve ◽

Clinical Outcomes ◽

Transcatheter Aortic Valve Implantation ◽

Outcomes Research ◽

Cardiovascular Outcomes ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

The Uk ◽

Valve Implantation

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Novel United Kingdom prognostic model for 30-day mortality following transcatheter aortic valve implantation

Heart ◽

10.1136/heartjnl-2017-312489 ◽

2017 ◽

Vol 104 (13) ◽

pp. 1109-1116 ◽

Cited By ~ 18

Author(s):

Glen P Martin ◽

Matthew Sperrin ◽

Peter F Ludman ◽

Mark A de Belder ◽

Simon R Redwood ◽

...

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Prediction Models ◽

Model Updating ◽

Characteristic Curve ◽

Predictive Performance ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

The Uk ◽

Valve Implantation

ObjectiveExisting clinical prediction models (CPM) for short-term mortality after transcatheter aortic valve implantation (TAVI) have limited applicability in the UK due to moderate predictive performance and inconsistent recording practices across registries. The aim of this study was to derive a UK-TAVI CPM to predict 30-day mortality risk for benchmarking purposes.MethodsA two-step modelling strategy was undertaken: first, data from the UK-TAVI Registry between 2009 and 2014 were used to develop a multivariable logistic regression CPM using backwards stepwise regression. Second, model-updating techniques were applied using the 2013–2014 data, thereby leveraging new approaches to include frailty and to ensure the model was reflective of contemporary practice. Internal validation was performed by bootstrapping to estimate in-sample optimism-corrected performance.ResultsBetween 2009 and 2014, up to 6339 patients were included across 34 centres in the UK-TAVI Registry (mean age, 81.3; 2927 female (46.2%)). The observed 30-day mortality rate was 5.14%. The final UK-TAVI CPM included 15 risk factors, which included two variables associated with frailty. After correction for in-sample optimism, the model was well calibrated, with a calibration intercept of 0.02 (95% CI −0.17 to 0.20) and calibration slope of 0.79 (95% CI 0.55 to 1.03). The area under the receiver operating characteristic curve, after adjustment for in-sample optimism, was 0.66.ConclusionThe UK-TAVI CPM demonstrated strong calibration and moderate discrimination in UK-TAVI patients. This model shows potential for benchmarking, but even the inclusion of frailty did not overcome the need for more wide-ranging data and other outcomes might usefully be explored.

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