TY - JOUR

T1 - Evaluation of current practices in transcatheter aortic valve implantation

T2 - The WRITTEN (WoRldwIde TAVI ExperieNce) survey

AU - Cerrato, Enrico

AU - Nombela-Franco, Luis

AU - Nazif, Tamim M

AU - Eltchaninoff, Helene

AU - Søndergaard, Lars

AU - Ribeiro, Henrique B

AU - Barbanti, Marco

AU - Nietlispach, Fabian

AU - De Jaegere, Peter

AU - Agostoni, Pierfrancesco

AU - Trillo, Ramiro

AU - Jimenez-Quevedo, Pilar

AU - D'Ascenzo, Fabrizio

AU - Wendler, Olaf

AU - Maluenda, Gabriel

AU - Chen, Mao

AU - Tamburino, Corrado

AU - Macaya, Carlos

AU - Leon, Martin B

AU - Rodes-Cabau, Josep

N1 - Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

PY - 2017

Y1 - 2017

N2 - 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.

AB - 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.

KW - Aortic Valve Stenosis/surgery

KW - Fibrinolytic Agents/therapeutic use

KW - Humans

KW - Patient Selection

KW - Postoperative Care

KW - Practice Patterns, Physicians'

KW - Surveys and Questionnaires

KW - Transcatheter Aortic Valve Replacement

U2 - 10.1016/j.ijcard.2016.11.104

DO - 10.1016/j.ijcard.2016.11.104

M3 - Journal article

C2 - 27883975

VL - 228

SP - 640

EP - 647

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -