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Int J Cardiol. 2017 Feb 1;228:640-647. doi: 10.1016/j.ijcard.2016.11.104. Epub 2016 Nov 9.

Evaluation of current practices in transcatheter aortic valve implantation: The WRITTEN (WoRldwIde TAVI ExperieNce) survey.

Author information

1
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Unified Interventional Cardiology Unit, San Luigi Gonzaga Orbassano University Hospital, Rivoli Infermi Hospital, Turin, Italy.
2
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain. Electronic address: luisnombela@yahoo.com.
3
Columbia University Medical Center, NewYork-Presbyterian Hospital, the Cardiovascular Research Foundation, NY, New York, USA.
4
Cardiology department, Charles Nicolle Hospital, University of Rouen, Rouen, France.
5
The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
6
Heart Institute (InCor), São Paulo University Medical School (USP), São Paulo, Brazil.
7
Ferrarotto Hospital, University of Catania, Catania, Italy.
8
University Heart Center, Hospital Zurich, Zurich, Switzerland.
9
Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands.
10
St. Antonius Hospital, Nieuwegein, Netherlands.
11
Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
12
Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
13
University of Turin, Città della Salute e della Scienza Hospital, Turin, Italy.
14
King's College Hospital, London, UK.
15
Clinica Alemana, Santiago, Chile.
16
West China Hospital, Sichuan University, China.
17
Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. Electronic address: josep.rodes@criucpq.ulaval.ca.

Abstract

BACKGROUND:

Transcatheter aortic valve implantation (TAVI) has been adopted worldwide as the standard treatment for severe aortic stenosis in symptomatic patients at prohibitive or high surgical risk, but there are still several areas where consensus and evidence are lacking. The purpose was to obtain a global view of current practice related to TAVI with the potential to identify the main areas of consensus and divergence between centers.

METHODS:

An online questionnaire was distributed in centers performing TAVI including a total of 59 questions concerning pre-procedural evaluation, procedural practices and post-procedural management.

RESULTS:

The survey was completed by 250 centers (with a cumulative experience of nearly 70,000 TAVI) from 38 different countries. Heart team meetings and surgical risk scores were routinely performed in most (>95%) centers, but frailty (44%) and quality of life (28%) assessments were less frequently performed. General anesthesia remained the most frequent type of anesthesia (60% of centers), and significant variability was detected in the examinations for residual aortic regurgitation assessment during the procedure and in post-procedural ECG monitoring and temporary pacemaker implementation (from none to ≥72h post-TAVI). Dual antiplatelet therapy duration post-TAVI was highly variable (1, 3, and ≥6months in 14%, 41% and 32% of centers, respectively) and lack of consensus in antithrombotic regimen was observed in patients with atrial fibrillation requiring anticoagulation therapy (anticoagulation alone, anticoagulation+aspirin, anticoagulation+clopidogrel, and triple therapy in 28%, 37%, 26% and 4% of centers, respectively).

CONCLUSIONS:

The WRITTEN survey provided extensive data on current TAVI-related practice and identified important differences between centers in key aspects of pre-, intra-, and post-operative management. This highlights the urgent need for further studies and evidence-based data to guide multiple aspects of the TAVI field.

KEYWORDS:

Real world assessment valvular stenosis; TAVI; TAVR; Web-based survey

PMID:
27883975
DOI:
10.1016/j.ijcard.2016.11.104
[Indexed for MEDLINE]

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