Data showed the median age of patients undergoing TAVR has slightly gone down from early TAVR experiences. In 2019 mostly males (56%) underwent TAVR, a shift away from the early TAVR period when there was a nearly equal male/female distribution of patients undergoing the procedure. For all years, patients undergoing TAVR were predominantly white with the persistence of under-representation of blacks, based on overall U.S. demographics, at 4% despite the substantial growth of sites offering TAVR. This finding will stimulate further research into its possible causes ranging from barriers to health care access to differences in the prevalence of disease. From 2011 thru 2018 extreme and high-risk patients remain the largest cohort undergoing TAVR, but in 2019 intermediate-risk was the largest cohort. In 2019, the first year TAVR was FDA-approved for low-risk patients, this population made up 11.5% of all TAVR patients and had a median age of 75.
In the early TAVR period with very large vascular sheaths required for the first-generation TAVR delivery catheters, only 57.1% of TAVR procedures used femoral artery access. By the current TAVR period in 2019, femoral access accounted for 95.3% of vascular access sites for the procedure. In 2019 the axillary-subclavian was the most commonly used alternative access approach, a shift from the use of transapical and direct aortic approaches that were the common alternative access point in the early TAVR period.
The median length of stay for patients has declined from seven days to two days for all patients over the course of the report. For patients assessed as low-risk, the median length of stay in 2019 was only one-day--an overnight hospital stay--with some patients discharged the same day. In the early TAVR period, most patients were discharged to another care facility. In 2019 90.3% of patients were discharged home, while 6.6% were discharged to a rehabilitation or extended care facility and 2.45% to a nursing home. Researchers also found a steady and dramatic shift in mortality from the early TAVR period to 2019. In-hospital mortality fell from 5.4% to 1.3% and 30-day mortality decreased from 7.2% to 2.5%. In-hospital and 30-day stroke rates also fell from the early TAVR period to the current TAVR period. However, the 30-day pacemaker implantation rate has remained largely the same. The in-hospital rate has fallen in the context of the shorter length of stay at the hospital.
The STS/ACC TVT Registry has been innovative in gathering data from patients on their assessment of their individual health status, using the Kansas City Cardiomyopathy Questionnaire (KCCQ) before treatment. The registry also gathers data on whether there are changes post-TAVR in component metrics on quality of life (QOL), functional state and other patient reported outcomes. In 2018--the most recent year with one-year outcomes data for patients treated on or before September 30--80.7% of all patients who were alive at one-year post-TAVR and had complete KCCQ data reported a good QOL. In addition, a subgroup analysis revealed that this benchmark was achieved in 77.7% of high-extreme risk, 83.6% of intermediate-risk and 85.8% of low-risk patients.
