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

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• 作者：Enrico Cerrato^a ; ^b ; ¹ ; Luis Nombela-Franco^a ; ¹ ; ^{luisnombela@yahoo.com} ; Tamim M. Nazif^c ; Helene Eltchaninoff^d ; Lars Sø ; ndergaard^e ; Henrique B Ribeiro^f ; Marco Barbanti^g ; Fabian Nietlispach^h ; Peter De Jaegereⁱ ; Pierfrancesco Agostoni^j ; Ramiro Trillo^k ; Pilar Jimenez-Quevedo^a ; Fabrizio D'Ascenzo^l ; Olaf Wendler^m ; Gabriel Maluendaⁿ ; Mao Chen^o ; Corrado Tamburino^g ; Carlos Macaya^a ; Martin B. Leon^c ; Josep Rodes-Cabau^p ; ^{josep.rodes@criucpq.ulaval.ca}
• 关键词：TAVI ; TAVR ; Real world assessment valvular stenosis ; Web-based survey
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 February 2017
• 年：2017
• 卷：228
• 期：Complete
• 页码：640-647
• 全文大小：701 K
• 卷排序：228

文摘

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.MethodsAn online questionnaire was distributed in centers performing TAVI including a total of 59 questions concerning pre-procedural evaluation, procedural practices and post-procedural management.ResultsThe 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 ≥ 72 h post-TAVI). Dual antiplatelet therapy duration post-TAVI was highly variable (1, 3, and ≥ 6 months 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).ConclusionsThe 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.