Patterns and trends of transcatheter aortic valve implantation in Italy: insights from RISPEVA
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Arturo Giordano1, Nicola Corcione, Giuseppe Biondi-Zoccai
1aUnità Operativa di Interventistica Cardiovascolare, Presidio Ospedaliero Pineta Grande, Castel Volturno, and Unità Operativa di Emodinamica, Casa di Salute Santa Lucia, San Giuseppe Vesuviano bDepartment of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, and Department of AngioCardioNeurology, IRCCS Neuromed, Pozzili cDivisione di Cardiologia, Fondazione Gabriele Monasterio, Massa dDivision of Cardiology, University of Pisa, Pisa eDivisione di Cardiologia, Azienda Ospedaliera di Siena, Siena fDivision of Interventional Cardiology, IRCCS Humanitas, Rozzano gDivision of Cardiology, San Giovanni di Dio e Ruggi D'Aragona Hospital, Salerno hCardiovascular, Respiratory, Nephrologic and Geriatric Sciences Department, Umberto I Hospital, Sapienza University of Rome, Rome iDivisione di Cardiologia, Centro Cardiologico Monzino, Milano jDivisione di Cardiologia, Azienda Ospedaliera di Trento, Trento kDivision of Cardiology, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro lUnità Operativa Complessa di Cardiologia Interventistica, Anthea Hospital, GVM Care & Research, Bari mDivision of Cardiology, Maria Pia Hospital, Torino nInterventional Cardiovascular Unit, Maria Cecilia Hospital, GVM Care and Research, Cotignola oDepartment of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.
Aims:
Clinical trials have shown that transcatheter aortic valve implantation for aortic stenosis compares favorably to surgical replacement in high-risk patients and is superior to medical therapy in those at prohibitive risk. There is uncertainty however on patterns and trends in transcatheter aortic valve implantation, especially focusing on Italy.
Methods:
The RISPEVA study is a prospective Italian registry including 21 institutions. Patients have been enrolled since late 2012, and data collection includes several baseline, procedural, in-hospital, and follow-up details. For the present analysis on patterns and trends, we focused on patients enrolled between 2012 and 2015, and as primary variable on the prevalence of high versus prohibitive surgical risk, limiting our scope to procedural outcomes.
Results:
A total of 1157 patients were included. The temporal breakdown was 376 (33%) patients enrolled in 2013, 408 (35%) in 2014, and 373 (32%) in 2015. Several patient features differed over time, including risk score, peripheral artery disease, end-stage pulmonary disease, and prior valvuloplasty (all P < 0.05). Several procedural features differed significantly over time, including sheath size, use of general anesthesia, Prostar closure device, predilation, antiembolic device, new TAVI device, and multiple prostheses (all P < 0.05). No significant temporal differences were found for major clinical outcomes, whereas the occurrence of moderate or severe postprocedural regurgitation and pacemaker dependency decreased over the years (both P < 0.05).
Conclusion:
According to the RISPEVA results, the Italian uptake of TAVI is steady, with evident trends toward less invasive approaches and fitter patients.
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