uk national audit transcatheter aortic valve implantation
TRANSCRIPT
2019-20 data
To Contents
Data extract
20-10-2020
UK National Audit Transcatheter Aortic Valve
Implantation
1st April 2019 to 31st March 2020
Peter F Ludman
BCIS Audit Lead On behalf of
British Cardiovascular Intervention Society
2019-20 data
To Contents
Data extract
20-10-2020
Transcatheter Aortic Valve Implantation
41 centres
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI
Procedure Numbers
Survey
COVID-19
2019-20 data
To Contents
Data extract
20-10-2020
Leyva, F et al Europace 2021
-64% -41%
-58% -21%
-28% -44%
-43% -45%
-83% -64%
National Lock Down
23rd March
% = change in activity over
3 months cf previous year
2019-20 data
To Contents
Data extract
20-10-2020
TAVI
66 297
557 781
1037 1290
1532
1872
2516
3410
3991
5197
6076
0
1000
2000
3000
4000
5000
6000
7000
Number per Year
91 pmp
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI
40.2
32.8
24.4
18.8 22.2
34.4 35.5
17.0
30.2
16.9
0
5
10
15
20
25
30
35
40
45
Rate of Increase in Procedures
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Europe 2019
Ali N, Open Heart 2021;8:e001547. doi:10.1136/ openhrt-2020-001547
2019-20 data
To Contents
Data extract
20-10-2020
TAVI 2018-19
Country
Treated
Number
of
Centres
Total
TAVI
Population
mid 2019
TAVI
pmp
England 35 5224 5.224 93
Wales 2 250 3.152 79
Scotland 3 400 5.463 73
Northern Ireland 1 202 1.894 107
ALL 41 6076 6.68 91
Survey
2019-20 data
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Data extract
20-10-2020
TAVI 2018-19
80
65 57
120
78
93
79 73
107
91
0
20
40
60
80
100
120
140
Eng
land
Wale
s
Scotla
nd
No
rthern
Ire
land
UK
To
tal
TAVI pmp
2018-19
2019-20
Survey
2019-20 data
To Contents
Data extract
20-10-2020 TAVI Extract
26-04-2020
TAVI 2018-19
Survey
2019-20 data
To Contents
Data extract
20-10-2020 TAVI Extract
26-04-2020 TAVI 2018-19
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI pmp by CCG 2018-19
0
50
100
150
200
250
NH
S E
rew
ash C
CG
NH
S N
orw
ich C
CG
NH
S B
radfo
rd D
istr
icts
CC
G
NH
S L
ew
isham
CC
G
NH
S D
on
caste
r C
CG
NH
S D
ors
et C
CG
NH
S H
ull
CC
G
NH
S S
outh
am
pto
n C
CG
NH
S E
ast Lancashire C
CG
NH
S W
igan B
oro
ugh C
CG
NH
S W
arw
ickshire
Nort
h C
CG
NH
S S
andw
ell
and
West
Birm
ingh
am
CC
G
NH
S C
am
brid
geshire a
nd P
ete
rboro
ugh C
CG
NH
S B
olton C
CG
NH
S H
eyw
ood, M
iddle
ton a
nd R
ochdale
CC
G
NH
S C
oventr
y a
nd R
ugby C
CG
NH
S B
ury
CC
G
NH
S B
lackburn
with D
arw
en C
CG
NH
S T
ow
er
Ham
lets
CC
G
NH
S N
ort
h E
ast Lin
coln
shire
CC
G
NH
S N
ort
h K
irkle
es C
CG
NH
S S
om
ers
et C
CG
NH
S N
ort
h L
incoln
sh
ire C
CG
NH
S H
ou
nslo
w C
CG
NH
S S
t H
ele
ns C
CG
NH
S D
urh
am
Dale
s, E
asin
gto
n a
nd S
edgefie
ld…
NH
S E
ast S
tafford
shire C
CG
NH
S W
est S
uffolk
CC
G
NH
S B
ark
ing a
nd D
agenham
CC
G
NH
S M
ore
cam
be B
ay C
CG
NH
S W
est E
ssex C
CG
NH
S B
erk
shire W
est C
CG
NH
S W
arr
ingto
n C
CG
NH
S N
ort
h T
ynesid
e C
CG
NH
S S
outh
Worc
este
rshire C
CG
NH
S S
wale
CC
G
NH
S G
rea
ter
Pre
sto
n C
CG
NH
S W
altham
Fo
rest C
CG
NH
S C
ald
erd
ale
CC
G
NH
S B
asild
on a
nd B
rentw
ood C
CG
NH
S S
outh
Kent C
oast C
CG
NH
S G
louce
ste
rshire C
CG
NH
S B
arn
et C
CG
NH
S N
ort
h D
urh
am
CC
G
NH
S S
outh
Easte
rn H
am
pshire C
CG
NH
S C
am
den C
CG
NH
S R
ichm
ond C
CG
NH
S H
am
ble
ton, R
ichm
ondshire a
nd W
hitby C
CG
NH
S W
est K
ent C
CG
NH
S L
ee
ds C
CG
NH
S E
alin
g C
CG
NH
S S
outh
Cheshire C
CG
NH
S W
irra
l C
CG
NH
S O
xfo
rdshire C
CG
NH
S B
exle
y C
CG
NH
S N
ort
h W
est S
urr
ey C
CG
NH
S S
urr
ey D
ow
ns C
CG
NH
S S
underla
nd C
CG
NH
S N
ott
ing
ham
West C
CG
NH
S T
hanet C
CG
NH
S E
astb
ourn
e, H
ails
ham
and S
eafo
rd C
CG
NH
S N
ort
h S
tafford
shire C
CG
NH
S N
ew
ark
and S
herw
ood C
CG
NH
S S
hro
pshire C
CG
NH
S F
yld
e a
nd W
yre
CC
G
NB Not all Hospital names visible in graphic
2019-20 data
To Contents
Data extract
20-10-2020
TAVI pmp by CCG 2018-19 Lowest 100
0
10
20
30
40
50
60
70
80
NH
S Er
ewas
h C
CG
NH
S H
ard
wic
k C
CG
NH
S B
asse
tlaw
CC
GN
HS
No
rwic
h C
CG
NH
S Sh
effi
eld
CC
GN
HS
Bra
dfo
rd C
ity
CC
GN
HS
Bra
dfo
rd D
istr
icts
CC
GN
HS
Isle
of
Wig
ht
CC
GN
HS
Thu
rro
ck C
CG
NH
S Le
wis
ham
CC
GN
HS
Old
ham
CC
GN
HS
Sou
th N
orf
olk
CC
GN
HS
Do
nca
ster
CC
GN
HS
Milt
on
Key
nes
CC
GN
HS
No
rth
Eas
t H
amp
shir
e an
d F
arn
ham
CC
GN
HS
Do
rset
CC
GN
HS
Wes
t N
orf
olk
CC
GN
HS
Ne
wh
am C
CG
NH
S H
ull
CC
GN
HS
East
Rid
ing
of
York
shir
e C
CG
NH
S M
anch
este
r C
CG
NH
S So
uth
amp
ton
CC
GN
HS
Gre
at Y
arm
ou
th a
nd
Wav
eney
CC
GN
HS
Bar
nsl
ey C
CG
NH
S Ea
st L
anca
shir
e C
CG
NH
S R
oth
erh
am C
CG
NH
S Ta
mes
ide
and
Glo
sso
p C
CG
NH
S W
igan
Bo
rou
gh C
CG
NH
S So
uth
war
k C
CG
NH
S Su
rre
y H
eat
h C
CG
NH
S W
arw
icks
hir
e N
ort
h C
CG
NH
S C
ity
and
Hac
kney
CC
GN
HS
Mer
ton
CC
GN
HS
San
dw
ell a
nd
Wes
t B
irm
ingh
am C
CG
NH
S La
mb
eth
CC
GN
HS
Luto
n C
CG
NH
S C
amb
rid
gesh
ire
and
Pet
erb
oro
ugh
CC
GN
HS
Sou
th W
est
Lin
coln
shir
e C
CG
NH
S M
id E
sse
x C
CG
NH
S B
olt
on
CC
GN
HS
Wan
dsw
ort
h C
CG
NH
S A
ire
dal
e, W
har
fed
ale
and
Cra
ven
CC
GN
HS
Hey
wo
od
, Mid
dle
ton
an
d R
och
dal
e C
CG
NH
S Le
ices
ter
Cit
y C
CG
NH
S P
ort
smo
uth
CC
GN
HS
Co
ven
try
and
Ru
gby
CC
GN
HS
Wes
t H
amp
shir
e C
CG
NH
S H
artl
epo
ol a
nd
Sto
ckto
n-o
n-T
ees
CC
GN
HS
Bu
ry C
CG
NH
S Li
verp
oo
l CC
GN
HS
Bed
ford
shir
e C
CG
NH
S B
lack
bu
rn w
ith
Dar
wen
CC
GN
HS
Bri
sto
l, N
ort
h S
om
erse
t an
d S
ou
th…
NH
S M
ansf
ield
an
d A
shfi
eld
CC
GN
HS
Tow
er H
amle
ts C
CG
NH
S Is
lingt
on
CC
GN
HS
East
Ber
ksh
ire
CC
GN
HS
No
rth
Eas
t Li
nco
lnsh
ire
CC
GN
HS
Dar
lingt
on
CC
GN
HS
Val
e R
oya
l CC
GN
HS
No
rth
Kir
klee
s C
CG
NH
S Sw
ind
on
CC
GN
HS
Co
rby
CC
GN
HS
Som
ers
et C
CG
NH
S N
ott
ingh
am C
ity
CC
GN
HS
Bre
nt
CC
GN
HS
No
rth
Lin
coln
shir
e C
CG
NH
S H
arin
gey
CC
GN
HS
Sutt
on
CC
GN
HS
Ho
un
slo
w C
CG
NH
S So
uth
Tyn
esid
e C
CG
NH
S K
no
wsl
ey C
CG
NH
S St
Hel
en
s C
CG
NH
S W
est
Lan
cash
ire
CC
GN
HS
East
an
d N
ort
h H
ertf
ord
shir
e C
CG
NH
S D
urh
am D
ales
, Eas
ingt
on
an
d S
edge
fiel
d C
CG
NH
S H
alto
n C
CG
NH
S W
est
Lon
do
n C
CG
NH
S Ea
st S
taff
ord
shir
e C
CG
NH
S N
ew
cast
le G
ates
hea
d C
CG
NH
S W
iltsh
ire
CC
GN
HS
Wes
t Su
ffo
lk C
CG
NH
S G
reat
er H
ud
der
sfie
ld C
CG
NH
S C
ante
rbu
ry a
nd
Co
asta
l CC
GN
HS
Bar
kin
g an
d D
agen
ham
CC
GN
HS
Sou
th L
inco
lnsh
ire
CC
GN
HS
Lin
coln
shir
e W
est
CC
GN
HS
Mo
reca
mb
e B
ay C
CG
NH
S Sa
lfo
rd C
CG
NH
S B
ath
an
d N
ort
h E
ast
Som
erse
t C
CG
NH
S W
est
Esse
x C
CG
NH
S N
ort
h N
orf
olk
CC
GN
HS
Val
e o
f Yo
rk C
CG
NH
S B
erks
hir
e W
est
CC
GN
HS
Cro
ydo
n C
CG
NH
S Sc
arb
oro
ugh
an
d R
yed
ale
CC
GN
HS
War
rin
gto
n C
CG
NH
S W
est
Ch
esh
ire
CC
GN
HS
Ne
ne
CC
G
2019-20 data
To Contents
Data extract
20-10-2020
TAVI pmp by CCG 2018-19 Highest 100
0
20
40
60
80
100
120
140
160
NH
S V
ale
of
York
CC
GN
HS
Ber
ksh
ire
Wes
t C
CG
NH
S C
royd
on
CC
GN
HS
Scar
bo
rou
gh a
nd
Rye
dal
e C
CG
NH
S W
arri
ngt
on
CC
GN
HS
Wes
t C
hes
hir
e C
CG
NH
S N
ene
CC
GN
HS
No
rth
Tyn
esid
e C
CG
NH
S G
reen
wic
h C
CG
NH
S K
ings
ton
CC
GN
HS
Sou
th W
orc
este
rsh
ire
CC
GN
HS
Wes
t Le
ices
ters
hir
e C
CG
NH
S D
erb
y an
d D
erb
ysh
ire
CC
GN
HS
Swal
e C
CG
NH
S N
ort
h E
ast
Esse
x C
CG
NH
S A
shfo
rd C
CG
NH
S G
reat
er P
rest
on
CC
GN
HS
Wak
efie
ld C
CG
NH
S So
uth
Tee
s C
CG
NH
S W
alth
am F
ore
st C
CG
NH
S Li
nco
lnsh
ire
East
CC
GN
HS
Bir
min
gham
an
d S
olih
ull
CC
GN
HS
Cal
der
dal
e C
CG
NH
S Ea
st S
urr
ey C
CG
NH
S So
uth
Eas
t St
affo
rdsh
ire
and
Sei
sdo
n P
en
insu
la C
CG
NH
S B
asild
on
an
d B
ren
two
od
CC
GN
HS
No
rth
Ham
psh
ire
CC
GN
HS
Cas
tle
Po
int
and
Ro
chfo
rd C
CG
NH
S So
uth
Ken
t C
oas
t C
CG
NH
S D
evo
n C
CG
NH
S W
olv
erh
amp
ton
CC
GN
HS
Glo
uce
ster
shir
e C
CG
NH
S W
yre
Fore
st C
CG
NH
S En
fiel
d C
CG
NH
S B
arn
et C
CG
NH
S K
ern
ow
CC
GN
HS
Ch
orl
ey a
nd
So
uth
Rib
ble
CC
GN
HS
No
rth
Du
rham
CC
GN
HS
Red
bri
dge
CC
GN
HS
Bla
ckp
oo
l CC
GN
HS
Sou
th E
aste
rn H
amp
shir
e C
CG
NH
S So
uth
end
CC
GN
HS
Fare
ham
an
d G
osp
ort
CC
GN
HS
Cam
den
CC
GN
HS
East
ern
Ch
esh
ire
CC
GN
HS
Du
dle
y C
CG
NH
S R
ich
mo
nd
CC
GN
HS
Hav
erin
g C
CG
NH
S H
erts
Val
leys
CC
GN
HS
Ham
ble
ton
, Ric
hm
on
dsh
ire
and
Wh
itb
y C
CG
NH
S H
amm
ersm
ith
an
d F
ulh
am C
CG
NH
S N
ott
ingh
am N
ort
h a
nd
Eas
t C
CG
NH
S W
est
Ken
t C
CG
NH
S W
alsa
ll C
CG
NH
S N
ort
hu
mb
erla
nd
CC
GN
HS
Leed
s C
CG
NH
S So
uth
Sef
ton
CC
GN
HS
Med
way
CC
GN
HS
Ealin
g C
CG
NH
S B
uck
ingh
amsh
ire
CC
GN
HS
Ipsw
ich
an
d E
ast
Suff
olk
CC
GN
HS
Sou
th C
hes
hir
e C
CG
NH
S H
eref
ord
shir
e C
CG
NH
S C
oas
tal W
est
Suss
ex C
CG
NH
S W
irra
l CC
GN
HS
Sou
th W
arw
icks
hir
e C
CG
NH
S B
rom
ley
CC
GN
HS
Oxf
ord
shir
e C
CG
NH
S St
ock
po
rt C
CG
NH
S G
uild
ford
an
d W
aver
ley
CC
GN
HS
Bex
ley
CC
GN
HS
East
Lei
cest
ersh
ire
and
Ru
tlan
d C
CG
NH
S B
righ
ton
an
d H
ove
CC
GN
HS
No
rth
Wes
t Su
rrey
CC
GN
HS
Hill
ingd
on
CC
GN
HS
Cra
wle
y C
CG
NH
S Su
rrey
Do
wn
s C
CG
NH
S Tr
affo
rd C
CG
NH
S R
edd
itch
an
d B
rom
sgro
ve C
CG
NH
S Su
nd
erla
nd
CC
GN
HS
Ho
rsh
am a
nd
Mid
Su
ssex
CC
GN
HS
Cen
tral
Lo
nd
on
(W
estm
inst
er)
CC
GN
HS
No
ttin
gham
Wes
t C
CG
NH
S H
arro
gate
an
d R
ura
l Dis
tric
t C
CG
NH
S N
ort
h C
um
bri
a C
CG
NH
S Th
anet
CC
GN
HS
Dar
tfo
rd, G
rave
sham
an
d S
wan
ley
CC
GN
HS
Telf
ord
an
d W
reki
n C
CG
NH
S Ea
stb
ou
rne,
Hai
lsh
am a
nd
Sea
ford
CC
GN
HS
Har
row
CC
GN
HS
Staf
ford
an
d S
urr
ou
nd
s C
CG
NH
S N
ort
h S
taff
ord
shir
e C
CG
NH
S So
uth
po
rt a
nd
Fo
rmb
y C
CG
NH
S H
asti
ngs
an
d R
oth
er C
CG
NH
S N
ewar
k an
d S
her
wo
od
CC
G
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Centres by Site Code
3 5
110
246
215
39
11 5
214
152
107
126
192
214
189
33 18
168
36
345
116
142
180
69
158
181 187
207
248
60
223
202
459
147
110
264 264
134 139
65
93
0
50
100
150
200
250
300
350
400
450
500
AH
M
AN
T
BA
S
BH
L
BR
I
CH
H
CH
N
CR
O
ER
I
FR
E
GE
O
GJH
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
RIA
RS
C
RV
B
SB
H
SC
M
SG
H
ST
H
ST
O
UH
W
VIC
WA
L
WY
T
2016
2017
2018-19
2019-20
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Centres by Procedures in 2019-20
3 5 5 11 18
33 36 39
60 65 69
93 107 110 110 116
126 134 139 142 147 152 158
168 180 181 187 189 192
202 207 214 214 215
223
246 248
264 264
345
459
0
50
100
150
200
250
300
350
400
450
500
AH
M
AN
T
CR
O
CH
N
HS
C
HH
W
LB
H
CH
H
RIA
WA
L
NG
S
WY
T
GE
O
BA
S
SG
H
MO
R
GJH
UH
W
VIC
MR
I
SC
M
FR
E
NH
B
KC
H
NC
R
PA
P
PL
Y
HH
GR
L
RV
B
QE
B
ER
I
HA
M
BR
I
RS
C
BH
L
RA
D
ST
H
ST
O
LG
I
SB
H
2016
2017
2018-19
2019-20
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Extract 05-11-2020 v declared
NICOR 5736 (versus declared 6076 in Survey)
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Sex
60.6
44.1 48.1 46.4 47 47.5 46.5 45.5 45.5 45.5 44.1 45.6
0
10
20
30
40
50
60
70
% Female
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Age Mean
82.7 81.3 81.4 81.3 81 81.2 81 81.2 81.1 81.4 81.4 81.3
0
10
20
30
40
50
60
70
80
90
100
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
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 18.4
0
5
10
15
20
25
30
35
40
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Prior TAVI
24
21 21
19
20
21
22
23
24
25
2017 2018-19 2019-20
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Prior TAVI
TAVI Extract
5-11-2020
• Coronary access post V-in-V TAVI
2019-20 data
To Contents
Data extract
20-10-2020
PCI Prior or Staged/Hybrid
13.6 13.8 13.1
12.7 13.4
12.9
7.1
6.2 6.6
7.2
4.4 4.7
0
2
4
6
8
10
12
14
16
2014 2015 2016 2017 2018-19 2019-20
% of all TAVI Prior
Staged / Hybrid
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI for Aortic Bioprosthetic Valve Failure
66
84
115
132 137
210
0
50
100
150
200
250
2013 2014 2015 2016 2017 2018-19 2019-20
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI for Aortic Bioprosthetic Valve Failure
4.3 4.5 4.6
3.9
3.4 3.7
0
1
2
3
4
5
As % of all TAVI
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Percutaneous Valves TAVI Valve to treat failing bioprostheses
28
1 1
14
2 1
33
3 2
27
5
3
0
5
10
15
20
25
30
35
Mitral Tricuspid Pulmonary
Number of Procedures
2016
2017-18
2018-19
2019-20
Survey
2019-20 data
To Contents
Data extract
20-10-2020
Percutaneous Valves TAVI Valve to treat failing mitral bioprosthesis
6
5
4 4
2 2
1 1 1 1
0
1
2
3
4
5
6
7
BR
I
RS
C
HA
M
NH
B
SB
H
ST
H
BH
L
KC
H
LG
I
QE
B
Number of Procedures
2019-20
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI
Procedural Details
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Device Manufacturer
0
500
1000
1500
2000
2500
3000
Number of TAVIs
EDW
MED
BSC
SJM
SYM
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Delivery Approach
5203
0
1000
2000
3000
4000
5000
6000
200
7
200
8
20
09
201
0
201
1
201
2
201
3
201
4
201
5
201
6
201
7
201
8-1
9
201
9-2
0
Number of TAVIs
TF (percut)
TF surgical
TA
SC/Ax
DA
Carotid
Other
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Non Percutaneous TF Delivery Approach
0
50
100
150
200
250
Number of TAVIs
TF surgical
TA
SC/Ax
DA
Carotid
Other
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Delivery Approach
78 78
85 88 89 90
92 92 93 93 94 95 95 96 96 96 97 97 97 97 97 98 98 98 98 98 98 99 99 100 100 100 100 100 100
0
10
20
30
40
50
60
70
80
90
100
SG
H
MR
I
VIC
ER
I
PLY
BH
L
FR
E
CH
H
PA
P
GR
L
KC
H
RV
B
HA
M
ST
H
SC
M
LG
I
NC
R
RA
D
HH
MO
R
NH
B
QE
B
NG
S
WY
T
GE
O
RS
C
WA
L
SB
H
ST
O
AN
T
BA
S
CH
N
GJH
RIA
UH
W
Transfemoral (%)
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Delivery Approach
0 0 0 0 0 0 0 0 0 0 0
1 1 1
1 1 2 2 2 2 2 2 2 3 3 3 3
3 4 4 4
6
8 8
19
0
2
4
6
8
10
12
14
16
18
20
AN
T
BA
S
BH
L
CH
N
GJH
PA
P
PLY
RIA
SG
H
ST
H
UH
W
ST
O
SB
H
NG
S
KC
H
VIC
WA
L
RV
B
RS
C
NH
B
GE
O
QE
B
WY
T
HH
MO
R
RA
D
NC
R
HA
M
LG
I
SC
M
GR
L
ER
I
CH
H
FR
E
MR
I
Subclavian (%)
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Delivery Approach
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
1
2 3 3 4 4
6
7
10
11
22
0
5
10
15
20
25
AN
T
BA
S
CH
H
CH
N
FR
E
GE
O
GJH
HH
LG
I
MO
R
MR
I
NC
R
NG
S
QE
B
RA
D
RIA
RS
C
SB
H
SC
M
ST
O
UH
W
WA
L
WY
T
NH
B
HA
M
PA
P
GR
L
RV
B
KC
H
ST
H
ER
I
VIC
BH
L
PLY
SG
H
Transapical (%)
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Procedures where Cerebral Protection Device Used
1.1 0.9
0.7
1.2
1.9
1.1
4.2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2013 2014 2015 2016 2017 2018-19 2019-20
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
n=7730
Randomisation 1:1(Claret Sentinel device)
Primary end point: All stroke at 72 hours (or by hospital discharge)
2019-20 data
To Contents
Data extract
20-10-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Aortic Balloon Valvuloplasty Prior to TAVI Date
174 217 222 264 277 238 247
1354
1652
2288
2844
3365
4371
4756
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Number of TAVI
Procedures Yes
No
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Aortic Balloon Valvuloplasty Prior to TAVI Date
11.4 11.6
8.8 8.5
7.6
5.2
3.9
0
2
4
6
8
10
12
14
% of TAVI Procedures
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Aortic Balloon Valvuloplasty Prior to TAVI Date
? FRE error
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Aortic Balloon Valvuloplasty Prior to TAVI Date
2018-19 2019-20
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Aortic Balloon Valuloplasty (not as part of TAVI)
420 473 495
668
789 817 827
687 725
572
0
100
200
300
400
500
600
700
800
900
Survey
2019-20 data
To Contents
Data extract
20-10-2020
Aortic Balloon Valuloplasty (not as part of TAVI – as a % of TAVI)
53.8
45.6
38.4
43.6 42.1
32.5
24.3
17.2 14.0
9.4
0
10
20
30
40
50
60
Survey
2019-20 data
To Contents
Data extract
20-10-2020
TAVI GA v Conscious Sedation
631 835 962
1271 1336 1183
979 744
559 507 49 64 153 260
530
1325
2211
2974
4147
4958
0
1000
2000
3000
4000
5000
6000
2007
2008
20
09
2010
2011
2012
2013
2014
2015
2016
20
17
2018-1
9
2019-2
0
Number of TAVI
Procedures GA
Non GA
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Conscious Sedation
1.5
9.5 8.4 7.2 7.1
13.7 17.0
28.4
52.8
69.3
80.0
88.1 90.7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
TAVI under Conscious
Sedation (%)
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI GA v Conscious Sedation
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI GA v Conscious Sedation
TAVI Extract
5-11-2020
0 0 0 0 0 2 2 3 3 3 3 3
4 4 5 6 6 6 7 7 8 9 9
10 11 13 13 13
18
27
31
36 38
50
0
10
20
30
40
50
60
AN
TC
HN
FR
ER
IAS
CM
GJH
UH
WQ
EB
ST
OB
AS
WA
LR
SC
HH
HA
MS
BH
LG
IN
GS
RV
BP
AP
NC
RR
AD
ST
HG
RL
PLY
BH
LV
ICE
RI
KC
HC
HH
MR
IS
GH
GE
OW
YT
NH
B
General Anaesthetic (%)
2019-20 data
To Contents
Data extract
20-10-2020
TAVI GA v Conscious Sedation
TAVI Extract
5-11-2020
0
10
20
30
40
50
60
70
80
90
100
AN
T
CH
N
FR
E
RIA
SC
M
GJH
UH
W
QE
B
ST
O
BA
S
WA
L
RS
C
HH
HA
M
SB
H
LG
I
NG
S
RV
B
PA
P
NC
R
RA
D
ST
H
GR
L
PLY
BH
L
VIC
ER
I
KC
H
CH
H
MR
I
SG
H
GE
O
WY
T
NH
B
Conscious Sedation (%)
2019-20 data
To Contents
Data extract
20-10-2020
TAVI GA v Conscious Sedation
2018-19 -> 2019-20
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Time to TAVI and Dx
Admission to
TAVI (all)
TAVI to Dx
(all)
LOS (all) LOS
(elective)
Mean (days) 5.4 4.4 8.8 5.7
Median (days) 2.0 2.2 4 3
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
TAVI Length Of Stay
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
2019-20 data
To Contents
Data extract
20-10-2020
2015 Poland and France
2017 Portugal
2020 UK
https://www.valveforlife.co.uk/clinician-resources
2019-20 data
To Contents
Data extract
20-10-2020
https://www.valveforlife.co.uk/clinician-resources
2019-20 data
To Contents
Data extract
20-10-2020
Valve for Life Proposed Benchmark Standards
https://www.valveforlife.co.uk/clinician-resources
2019-20 data
To Contents
Data extract
20-10-2020
Aortic Stenosis Prognosis
Ali N, et al. Open Heart 2021;8:e001547
2019-20 data
To Contents
Data extract
20-10-2020
Valve for Life Proposed TAVI pathway
https://www.valveforlife.co.uk/clinician-resources
2019-20 data
To Contents
Data extract
20-10-2020
TAVI
Complications
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Implantation of PPM Due to TAVI All procedures
11.32
9.25 9.69
0
2
4
6
8
10
12
%
Pre-TAVI prophylactic
Per-TAVI
Post-TAVI
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Implantation of PPM Due to TAVI Edwards Sapien
6.3 6.1
6.9 7.5 7.8 7.8
7
0
1
2
3
4
5
6
7
8
9
%
Pre-TAVI prophylactic
Per-TAVI
Post-TAVI
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Implantation of PPM Due to TAVI Medtronic
14.4 15.4
18.3 18.5 18.4
16.2 14.8
0
2
4
6
8
10
12
14
16
18
20
%
Pre-TAVI prophylactic
Per-TAVI
Post-TAVI
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Post TAVI Aortic Regurgitation
62.4
57.4 55.2
60.6
34.2
39.1 41
36.5
3.2 3.2 3.6 2.7 0.2 0.3 0.2 0.3
0
10
20
30
40
50
60
70
2016 2017 2018-19 2019-20
%
None
Mild
Moderate
Severe
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Post TAVI Aortic Regurgitation
62.4
34.2
3.2
0.2
57.4
39.1
3.2 0.3
55.2
41
3.6
0.2
60.6
36.5
2.7 0.3
0
10
20
30
40
50
60
70
None Mild Moderate Severe
%
2016
2017
2018-19
2019-20
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Bail out PCI
0.4
0.27
0.45
0.41
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
2016 2017 2018-19 2019-20
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Tamponade
3
5.3
2.1
1.7 1.9
1.7
2.2 2.4
1.6 1.4
1.2 0.94 0.9
0
1
2
3
4
5
6
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Tamponade
TAVI Extract
5-11-2020
6
26
2
7
3
0
5
10
15
20
25
30
35
40
Surgical intervention Percutaneous intervention
n Not recorded
Died
Alive
2019-20 data
To Contents
Data extract
20-10-2020
Major Vascular Access Complication
3.1 3.1
3.3
2
2.3
2.83
2.3
0
0.5
1
1.5
2
2.5
3
3.5
2013 2014 2015 2016 2017 2018-19 2019-20
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Major Bleeding
0.87
1.1
0.68
1.73
1.44 1.57
4.13
3.83
3.26
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
2017 2018-19 2019-20
%
Life Threatening / Disabling
Major
Minor
TAVI Extract
5-11-2020
Life Threatening / Disabling = BARC 5, BARC 3b and 3c
Major = BARC 3a
Minor = BARC 2 or 3a according to severity
2019-20 data
To Contents
Data extract
20-10-2020
Conversion to Full Sternotomy
0.3
0.15
0.1
0
0.05
0.1
0.15
0.2
0.25
0.3
0.35
2019-20
%
Valve surgery
Haemorrhage
Other reason
TAVI Extract
5-11-2020
n=16 n=8 n=3
N=27
2019-20 data
To Contents
Data extract
20-10-2020
Conversion to Full Sternotomy
10
7
2
3
4
1
0
2
4
6
8
10
12
14
16
18
Valve Surgery Haemorrhage Other reason
n
Not recorded
Died
Alive
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
In Hospital CVA
3
2 2
2.2
2.6
2.3
2.1
0
0.5
1
1.5
2
2.5
3
3.5
2013 2014 2015 2016 2017 2018-19 2019-20
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
In Hospital CVA
Myat A et al. CCI 2020
• 8,652 TAVI procedures were performed from 2007 to 2015
• CVA in 205
2019-20 data
To Contents
Data extract
20-10-2020
In Hospital Mortality
4.7
3.5
2.5
1.8 2 2
1.3
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
2013 2014 2015 2016 2017 2018-19 2019-20
%
TAVI Extract
5-11-2020
2019-20 data
To Contents
Data extract
20-10-2020
Summary
• Rate has increased to 91 pmp
– UK low relative to Europe
– Marked UK regional variation
• Mean age and sex ratio unchanged
• Variation in TAVI practice
– Use of prior Aortic Balloon Valvuloplasty
– Conscious sedation (rather than GA)
– Vascular access
– Length of stay
• Outcomes
– Low rates of significant AR
– CVA remains < 3%
– Falling mortality (<2% this audit period)
• Developments
– Valve for Life initiative, Randomised trial of cerebral protection
2019-20 data
To Contents
Data extract
20-10-2020
Acknowledgment
• NICOR
– Sue Manuel (Senior Developer – Qreg5)
– Unfunded continuation of database support