Incidence and trends of patient MACE outcomes after Transcatheter Aortic Valve Implantation (TAVI): analysis by age and sex

Background: Patients undergoing a transcatheter aortic valve implantation (TAVI) are at risk for Major Adverse Cardiac Events (MACE). We describe temporal trends of TAVI-related MACEs, stratified by age and sex. Methods: We performed a retrospective analysis of TAVI patients from the Netherlands Heart Registration (NHR) between 2013 and 2022. The outcomes were: mortality at 30 days, mortality at one year, permanent pacemaker implantation at 30 days (PPI), major vascular complication at 30 days (MVC), and stroke at three days. We calculated incidence and trends in TAVI patients and their outcomes. Results: The cohort consisted of 19,746 TAVI patients, with a mean age of 80 years. The annual number of TAVI procedures increased over the years from 786 to 2876 (p < 0.001). Initially, more women received TAVI, but the trend shifted over time to more men (p < 0.001). Outcomes incidence was: 30-day mortality (3.3%), one-year mortality (10.6%), PPI (10.7%), MVC (2.9%), and stroke (2.0%). Incidence of both mortality outcomes decreased over time (6.7% to 2.7%, and 15.8% to 8.8% for 30-day and one-year mortality, respectively), as did PPI (12.3% to 10.4%) and MVC (3.6% to 2.5%). Women had a higher incidence of MVC and stroke. Men had a higher incidence of one-year mortality and PPI, and their incidence increased more with age than it did in women. Conclusion: The volume of TAVI procedures has increased significantly over time, while mortality, PPI, MVC, and MACE incidence have significantly decreased. Sex-specific differences in MACE outcome incidence were present.