Clinical studies in Transcatheter Aortic Valve Implantation (TAVI): a) Prospective assessment of central blood response to TAVI using 24-hour ambulatory blood pressure monitoring b) Trends in TAVI practice and clinical outcomes in Ireland

Abstract A

Background: Transcatheter Aortic Valve Implantation (TAVI) results in pressure generated by the left ventricle being transmitted directly to the aorta without restriction from a stenotic aortic valve. Limited studies have suggested these hemodynamic changes may result in a hypertensive response in approximately 50% of patients. However, these findings have not been validated beyond the time of hospital discharge.
Aims: To prospectively assess the impact of TAVI on estimated central blood pressure using a 24-hour ambulatory blood pressure monitor (ABPM).
Methods: Participating patients were fitted with a 24-hour ABPM within the 2 weeks before TAVI and again 6 weeks after TAVI. Post-TAVI hypertension was defined as a new finding of systolic BP ≥130mmHg or diastolic BP ≥80mmHg, a need for additional medication, or a doubling of current anti-hypertensive medication to control BP.
Results: Among the 20 patients (mean age 78±7.4, 70% male) included for BP analysis, 3 patients (15%) developed new hypertension at a median of 48 (IQR 41, 87) days after TAVI. The median central systolic increased from 133 (IQR 124, 144) mmHg to 135 (IQR 124, 151) mmHg post-TAVI, p=0.033, and the median diastolic pressure was similar pre-TAVI (71 (IQR 61, 77) mmHg) and post-TAVI (74 (IQR 64, 77) mmHg), p=0.257. No patient had their antihypertensive medication changed due to hypotension or hypertension after TAVI. One non-cardiovascular death was recorded during follow-up, and no patient required hospitalisation within 1 year of TAVI
Conclusion: A small proportion of patients undergoing TAVI developed a sustained increase in blood pressure post-procedure.


Abstract B

Background: Transcatheter aortic valve implantation (TAVI) has become a mainstay of treatment for severe aortic stenosis. However, there is a paucity of data on how TAVI practice has evolved in Ireland.
Aims: To analyse temporal trends in patient demographics, procedural characteristics and clinical outcomes since the inception of the Mater Hospital TAVI program in 2008.
Methods: The prospective Mater TAVI database was divided into temporal tertiles based on when TAVI was performed: Group A: November 2008-April 2013, Group B: April 2013-September 2017, Group C: September 2017-February 2022. Patient characteristics and clinical outcomes were compared across groups.
Results: A total of 1,063 (Group A: 59, Group B: 268, Group C: 736) patients were treated with TAVI during the study period (mean age 81.1±7.4, mean STS score 5.9±5.1). Patient characteristics were similar across Groups A, B, and C.
Conscious sedation (Group A: 0%, Group B: 59.9%, Group C: 90.2%, p<0.001) and femoral artery access (Group A: 76.3%, Group B: 90.7%, Group C: 96.6%, p<0.001) were used more frequently over time. The median length of hospital stay reduced from 9 (IQR 7,18) days in group A to 2 (IQR2,3) days in group C. The rate of in-hospital death and stroke were lower in Group C compared to Group A, 2.3% vs 6.8% and 1.0% vs 3.4%, respectively. At 1-year follow-up, there was no significant difference in the rate of death and/or stroke between Group A and C (adjusted hazard ratio 1.49, 95%CI [0.59-3.74].
Conclusion: Over the study period, the number of TAVI procedures performed per year increased each year, with a move towards a more minimalist procedure and shorter hospital stays.