TY - ABST

T1 - TCT-82 Evaluation of Current Practices in Transcatheter Aortic Valve Replacement: The WRITTEN (WoRldwIde TAVR ExperieNce) Survey

AU - Nombela-Franco, Luis

AU - Cerrato, Enrico

AU - Nazif, Tamim

AU - Eltchaninoff, Hélène

AU - Sondergaard, Lars

AU - Ribeiro, Henrique B

AU - Barbanti, Marco

AU - Nietlispach, Fabian

AU - Agostoni, Pierfrancesco

AU - Trillo, Ramiro

AU - Jimenez, Pilar

AU - D'Ascenzo, Fabrizio

AU - Wendler, Olaf

AU - Maluenda, Gabriel

AU - Chen, Mao-Sheng

AU - Tamburino, Corrado

AU - Macaya, Carlos

AU - Leon, Martin B

AU - Rodés-Cabau, Josep

PY - 2016/11

Y1 - 2016/11

N2 - Background Transcatheter aortic valve replacement (TAVR) has been adopted worldwide for the treatment of aortic stenosis, but there are still several areas where consensus and evidence are lacking. Objective:to obtain a global view of current practice related to TAVR with the potential to identify the main areas of consensus and divergence between centers. Methods An online questionnaire was distributed in centers performing TAVR irrespective of the number of procedures and valve type. The questionnaire was divided in 3 main blocks: pre-procedural evaluation, procedural practices and post-procedural management. Regional experts were recruited to distribute the survey in each country or region. Results The survey was completed by 250 TAVR centers (with a cumulative experience of nearly 70,000 procedures) from 38 different countries. Heart team meetings were regularly scheduled in most (>95%) centers with high participation of the interventional cardiologists (97%) and cardiac surgeons (96%), but rarely involvement of other specialists. Surgical risk scores were routinely used in 99% of the 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 performed to evaluate inmediate residual aortic regurgitation. The implementation and duration of post-procedure continuous ECG monitoring and temporary pacemaker also varied widely by center and valve type. While dual antiplatelet therapy was the most common antithrombotic regimen post-TAVR, its duration was highly variable (1, 3, and ≥6 months in 14%, 41% and 32% of centers, respectively). A lack of consensus was also observed in the choice of antithrombotic regimen 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). Conclusion The WRITTEN survey provided extensive data on current TAVR-related practice and identified important differences between centers in key aspects of pre-, intra-, and post-operative management.

AB - Background Transcatheter aortic valve replacement (TAVR) has been adopted worldwide for the treatment of aortic stenosis, but there are still several areas where consensus and evidence are lacking. Objective:to obtain a global view of current practice related to TAVR with the potential to identify the main areas of consensus and divergence between centers. Methods An online questionnaire was distributed in centers performing TAVR irrespective of the number of procedures and valve type. The questionnaire was divided in 3 main blocks: pre-procedural evaluation, procedural practices and post-procedural management. Regional experts were recruited to distribute the survey in each country or region. Results The survey was completed by 250 TAVR centers (with a cumulative experience of nearly 70,000 procedures) from 38 different countries. Heart team meetings were regularly scheduled in most (>95%) centers with high participation of the interventional cardiologists (97%) and cardiac surgeons (96%), but rarely involvement of other specialists. Surgical risk scores were routinely used in 99% of the 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 performed to evaluate inmediate residual aortic regurgitation. The implementation and duration of post-procedure continuous ECG monitoring and temporary pacemaker also varied widely by center and valve type. While dual antiplatelet therapy was the most common antithrombotic regimen post-TAVR, its duration was highly variable (1, 3, and ≥6 months in 14%, 41% and 32% of centers, respectively). A lack of consensus was also observed in the choice of antithrombotic regimen 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). Conclusion The WRITTEN survey provided extensive data on current TAVR-related practice and identified important differences between centers in key aspects of pre-, intra-, and post-operative management.

U2 - 10.1016/j.jacc.2016.09.230

DO - 10.1016/j.jacc.2016.09.230

M3 - Conference abstract in journal

VL - 68

SP - B33-B34

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 18 S1

ER -