transcatheter aortic valve implantation - bcis€¦ · 2017 data (data extracted 06-11- 2018)...

2017 data

(data extracted 06-11- 2018)

SCTS Transcatheter

Aortic Valve Implantation

UK TAVI Audit Data

2007 to 2017

Peter Ludman

Audit Lead BCIS

Data extract 6th November 2018

2017 data


SCTS

TAVI Centres

2017 data


SCTS

2017 TAVI Centres

Barts Health Centre, St Bartholomew’s Hospital SBH

Basildon and Thurrock University Hospitals BAS

Blackpool Victoria Hospital VIC

Bristol Royal Infirmary BRI

City General Hospital (University Hospital of North Staffordshire) STO

Cromwell Hospital CRO

Derriford Hospital, Southwest Cardiothoracic Centre PLY

Edinburgh Heart Centre ERI

Freeman Hospital FRE

Glenfield Hospital GRL

Hammersmith Hospital HAM

Harley Street Clinic HSC

James Cook University Hospital SCM

John Radcliffe Hospital RAD

Kings College Hospital KCH

Liverpool Cardiothoracic Centre BHL

London Bridge Hospital LBH

Manchester Royal Infirmary MRI

Morriston Hospital MOR

New Cross Hospital NCR

Northern General Hospital NGS

Nottingham City Hospital CHN

Papworth Hospital PAP

Queen Elizabeth Hospital, Birmingham QEB

Royal Brompton Hospital and Harefield, Brompton site NHB

Royal Brompton Hospital and Harefield, Harefield site HH

Royal Sussex County Hospital RSC

Royal Victoria Hospital RVB

Southampton General Hospital SGH

St George's Hospital GEO

St Thomas' Hospital STH

University Hospital of Wales UHW

Walsgrave Hospital (University Hospital Coventry) WAL

Wellington Hospital HHW

Wythenshawe Hospital WYT

Yorkshire Heart Centre LGI

Code Name Code Name

2017 data


SCTS 2017 TAVI Centres

2017 data


SCTS

Number of Procedures

2017 data


SCTS

Case Ascertainment

Awaits Survey data

2017 data


SCTS Number of Procedures

Performed by Year

66 297

557 781

1037 1290

1532

1872

2516

3410

4019

0

500

1000

1500

2000

2500

3000

3500

4000

4500

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of TAVI

Procedures

Note: No 2017 data from WYT – estimate 70 (included in chart above)

Some missing 2017 data from KCH – confirmed total 117 (included in chart above)

UK rate 2017 = 61 pmp

2017 data


SCTS

Change in 2016 data

• Additional cases – NCR 91

– STH 21

– MOR 20

– KCH 19

– MRI 5

– SGH 3

– PLY 2

– RAD 1

– RVB 1

• Deleted cases – BRI -3

– SBH -3

– CHN -2

– SCM -2

– VIC -2

– ERI -1

2016 Total 3260 3410 +150

The 2016 data presented here are different to those displayed in the last analysis

due to modifications to the live dataset. The differences in the dataset state from

May 2017 (previous extract analysis) and November 2018 (current) are described

below

2017 data


SCTS TAVI by Centre

2017

• New Centres – ANT (8 cases)

– BAS (14 cases)

– NGS (45 cases)

• Total 36 UK Centres

• No 2017 data from WYT

• Missing data from KCH (27 of 117 cases uploaded)

2017 data


SCTS

TAVI by Centre

8 14

154

52

79

1

176

90

111

157

136

155

17 6

27 30

256

39

99

161

45

146

108 101

136

174

146

167

378

115

97

178

95

50

102

25

0

0

50

100

150

200

250

300

350

400

AN

T

BA

S

BH

L

BR

I

CH

N

CR

O

ER

I

FR

E

GE

O

GR

L

HA

M

HH

HH

W

HS

C

KC

H

LB

H

LG

I

MO

R

MR

I

NC

R

NG

S

NH

B

PA

P

PL

Y

QE

B

RA

D

RS

C

RV

B

SB

H

SC

M

SG

H

ST

H

ST

O

UH

W

VIC

WA

L

WY

T

2016

2017

Note: No 2017 data from WYT

Missing data from KCH – actual total 117

2017 data


SCTS TAVIs per Year by

Manufacturer

1664

2083

893

1308

573

138

55 82 79

167

0

500

1000

1500

2000

2500

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Number of TAVI Procedures

EDW

MED

BSC

SJM

SYM

2017 data


SCTS

Demographic Features

2017 data


SCTS

Age (median)

83.5 83 82 83 82 83 82 83 82 83 83

0

10

20

30

40

50

60

70

80

90

100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age (Years)

2017 data


SCTS

Age (mean)

82.7 81.3 81.4 81.3 81 81.2 81 81.2 81.1 81.4 81.4

0

10

20

30

40

50

60

70

80

90

100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Age (Years)

2017 data


SCTS Age (mean) by Centre

2017

2017 data


SCTS

Logistic EuroSCORE

• High levels of risk factor ‘missingness’

0

10

20

30

40

50

60

70

80

90

100

AN

T

BA

SB

HL

BR

IC

HN

CR

O

ER

IF

RE

GE

O

GR

LH

AM

HH

HH

WH

SC

KC

HL

BH

LG

IM

OR

MR

I

NC

RN

GS

NH

B

PA

PP

LY

QE

BR

AD

RS

C

RV

BS

BH

SC

M

SG

HS

TH

ST

OU

HW

VIC

WA

L

Percentage of All cases with

LES Risk Factors

Complete

2017 data


SCTS LES of centres with > 50%

cases recorded (mean)

• LES (mean of means) = 22.9

2017 data


SCTS

Female (%)

60.6

44.1 48.1 46.4 47 47.5 46.5 45.5 45.5 45.5 44.1

0

10

20

30

40

50

60

70

80

90

100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

%

2017 data


SCTS

On Dialysis

1.7 1.7

0

0.5

1

1.5

2

2.5

3

2016 2017

%

2017 data


SCTS

Diabetes (%)

16.7

24.2 23.3

20.7

23.3 22.3

23.7 24.5 24 23.5 23.3

0

5

10

15

20

25

30

35

40

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

%

2017 data


SCTS

Prior Cardiac Surgery (%)

22.7

29.6

32.1

34.1 32.8 33.4

32.3

28.8

26.5 24.9

20.5

0

5

10

15

20

25

30

35

40

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% of TAVI Procedures

2017 data


SCTS

Prior Cardiac Surgery (n)

430

494

539

667

804

707

0

100

200

300

400

500

600

700

800

900

2012 2013 2014 2015 2016 2017

Number of TAVI

Procedures

2017 data


SCTS PCI (%)

Prior or staged / hybrid 19.7

13.8 14.5

14.9

13.8 14.2

13.6 13.7 13.7 12.9 13.1

8 8.1

0

2

4

6

8

10

12

14

16

18

20

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

% Prior

Staged / hybrid

2017 data


SCTS Aortic Balloon Valvuloplasty

prior to TAVI date

174 217 222 264 277

1354

1652

2288

2844

3365

0

500

1000

1500

2000

2500

3000

3500

4000

2013 2014 2015 2016 2017

Number of TAVI

Procedures Yes

No

2017 data



prior to TAVI date

11.4 11.6

8.8 8.5

7.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

2013 2014 2015 2016 2017


2017 data



prior to TAVI date

2017 data


SCTS

Procedural details

2017 data


SCTS

Delivery Approach

3359

0

500

1000

1500

2000

2500

3000

3500

4000

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017


TF (percut)

TF surgical

TA

SC/Ax

DA

Carotid

Other

2017 data


SCTS Delivery Approach Detail: Other than Percutaneous TF

184

116

0 10

146

192 184

171 171 176

167 176

142

94

107

65

53

1 5

0

50

100

150

200

250

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017


TF surgical

TA

SC/Ax

DA

Carotid

Other

2017 data


SCTS Delivery Approach 2017 by Centre

2017 data


SCTS Cerebral Protection Used

17 17 18 39 70

1513

1848

2483

3278

3711

0

500

1000

1500

2000

2500

3000

3500

4000

2013 2014 2015 2016 2017


Yes

No

2017 data


SCTS Use of General Anaesthetic

0 65

239

457

631

835

962

1271 1336

1183

979

744

0 1 25 42 49 64 153

260

530

1325

2211

2974

0

500

1000

1500

2000

2500

3000

3500

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017


Yes

No

2017 data


SCTS Use of General Anaesthetic

1.5

9.5 8.4 7.2 7.1

13.7

17.0

28.4

52.8

69.3

80.0

0

10

20

30

40

50

60

70

80

90

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Non-GA Cases (%)

2017 data


SCTS

GA TAVI Procedures (%)

2017 data


SCTS GA TAVI Procedures

2016 v 2017 (%)

2016 2017

2017 data


SCTS

Non-GA TAVI Procedures (%)

2017 data


SCTS TAVI for Aortic

Bioprosthetic failure

66

84

115

132 137

0

20

40

60

80

100

120

140

160

2013 2014 2015 2016 2017

Number of TAVI

Procedures

2017 data


SCTS Pre-dilatation of AV

during TAVI

452

760

1479

2109

2736

1077 1102 1007 1001

913

1 2 2 3 3

0

500

1000

1500

2000

2500

3000

2013 2014 2015 2016 2017

Number of TAVI

Procedures

Not done

Successfully performed

Failed

2017 data


SCTS Pre-dilatation of AV

during TAVI

29.6

40.8

59.5

67.8

75.0

0

10

20

30

40

50

60

70

80

90

100

2013 2014 2015 2016 2017

%

% Not Performed

2017 data


SCTS Pre-dilatation of AV during TAVI

By Valve Manufacturer

34.5

75.6

25.2

31.2

74.5

86.1

56.2

0.0

17.0

23.6

71.6

82.5

0

10

20

30

40

50

60

70

80

90

100

%

2016

2017

2017 data


SCTS Post Implantation

Dilatation

296 415

2867

3222

0

500

1000

1500

2000

2500

3000

3500

2016 2017

Yes

No

2017 data


SCTS Post Implantation

Dilatation

9.4

11.4

0

2

4

6

8

10

12

14

16

18

20

2016 2017

%

2017 data


SCTS Post Implantation Dilatation

By Valve Manufacturer

1.9

8.2 5.9

19.5 18.9

15.8

10.2

33.3

7.4

14.1

30.9 31.3

0

5

10

15

20

25

30

35

40

%

2016

2017

2017 data


SCTS Time

TAVI to Dx (Days)

6.5

5.53

3 3

0

1

2

3

4

5

6

7

2016 2017

Days Mean

Median

2017 data


SCTS

Time

TAVI to Dx (Days)

Mean by Centre

2017 data


SCTS

Outcomes

2017 data


SCTS Implantation of PPM

Due to TAVI

6.3 6.1 6.9 7.5 7.8 7.8

0

5

10

15

20

25

30

35

40

45

50

2012 2013 2014 2015 2016 2017

Pre-TAVI prophylactic

Per-TAVI

Post-TAVI Edwards Sapien

%

2017 data



Due to TAVI

14.4 15.4 18.3 18.5 18.4

16.2

0

5

10

15

20

25

30

35

40

45

50

2012 2013 2014 2015 2016 2017


Per-TAVI

Post-TAVI Medtronic

%

2017 data



Due to TAVI

15.4

30.7 30.5

25.1

19.1

0

5

10

15

20

25

30

35

40

45

50

2013 2014 2015 2016 2017


Per-TAVI

Post-TAVI Boston

%

2017 data



Due to TAVI

5.3

10.5

0

5

10

15

20

25

30

35

40

45

50

2013 2014 2015 2016 2017


Per-TAVI

Post-TAVI Symetis

%

2017 data



Due to TAVI

10.4

0

5

10

15

20

25

30

35

40

45

50

2013 2014 2015 2016 2017


Per-TAVI

Post-TAVI St Jude Medical

%

2017 data


SCTS

Complications

13

10

32

40

0

5

10

15

20

25

30

35

40

45

2016 2017

Number of TAVI

Procedures Bail out PCI

Bail out V-in-V

2017 data


SCTS

Complications

0.4

0.27

1

1.1

0

0.2

0.4

0.6

0.8

1

1.2

2016 2017


Bail out PCI

Bail out V-in-V

2017 data


SCTS

Complications

0.53 0.52

0.31 0.3

0.12

0.24

0

0.1

0.2

0.3

0.4

0.5

0.6

2016 2017


Valve migration

Valve embolisation

Ectopic valvedeployment

2017 data


SCTS Post TAVI Aortic

regurgitation

62.4

34.1

3.2 0.2

57.4

39.1

3.2 0.3

0

10

20

30

40

50

60

70

None Mild Moderate Severe

% 2016

2017

2017 data


SCTS Post TAVI Aortic regurgitation

2017

0

10

20

30

40

50

60

70

0. None 1. Mild 2. Moderate 3. Severe


Boston Scientific

Direct Flow Medical

Edwards Lifesciences

Medtronic

St Jude Medical

Symetis

2017 data


SCTS Post TAVI Aortic regurgitation

2017

96.3

3.7

0.0

98.3

1.5 0.2

94.7

4.9 0.3

94.7

5.3

0.0

92.5

6.3

1.3

0

10

20

30

40

50

60

70

80

90

100

0. None / 1. Mild 2. Moderate 3. Severe


Boston Scientific

Direct Flow Medical

Edwards Lifesciences

Medtronic

St Jude Medical

Symetis

2017 data


SCTS Unsuccessful procedure

2017

0. NA (successful) 3541

1. Access site complication 15

1. Access site complication;5. Aborted due to vessel perforation/dissection 1

2. Failure to negotiate iliac vessels or aorta 4

2. Failure to negotiate iliac vessels or aorta;5. Aborted due to vessel

perforation/dissection 1

3. Unable to cross aortic arch 1

4. Unable to cross aortic valve 1

6. Aborted due to anticipated coronary obstruction 1

7. Aborted for other reason 9

7. Aborted for other reason;8. Not deployed for technical reason;9. Other

failure to deploy 1

8. Not deployed for technical reason 5

8. Not deployed for technical reason;9. Other failure to deploy 1

9. Other failure to deploy 7

2017 data


SCTS

Tamponade (%)

3

5.3

2.1 1.7

1.9 1.7

2.2 2.4

1.6 1.4

1.2

0

1

2

3

4

5

6

7

8

9

10

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

%

2017 data


SCTS Major Vascular Access

Complication %

3.1 3.1 3.3

2

2.3

0

0.5

1

1.5

2

2.5

3

3.5

4

2013 2014 2015 2016 2017

%

2017 data


SCTS New Haemofiltration or dialysis

post procedure (%)

1.52

6.42

4.32

3.85

4.37

2.51

2.96

1.6

0.82 0.95 0.68

0

1

2

3

4

5

6

7

8

9

10

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

%

2017 data


SCTS

In Hospital CVA %

3

2 2 2.2

2.6

0

1

2

3

4

5

2013 2014 2015 2016 2017

%

2017 data


SCTS

In Hospital Mortality %

4.7

3.5

2.5

1.8 2

0

1

2

3

4

5

2013 2014 2015 2016 2017

%

2017 data


SCTS

TAVI risk calculator

https://www.bcis.org.uk/resources/tavi-risk-calculator/






2017 data


SCTS

Acknowledgments

All staff at every TAVI centre for uploading procedural data

NICOR for maintaining the UK TAVI Registry data collection

transcatheter aortic valve implantation - bcis€¦ · 2017 data (data extracted 06-11- 2018)...

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