Resultados del implante percutáneo de válvula aórtica en España mediante el Registro de Actividad de Atención Especializada

Introduction and objectives: Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for the management of symptomatic severe aortic stenosis. As it happens with all procedures, the safety and effectiveness of TAVI must be monitored. To this end, we assessed the data available from the Spanish National Health Service from 2014 through 2017. Methods: The study included patients aged > 50 years treated with TAVI and registered in the Activity Registry of Specialized Health Care from 2014 through 2017 from public and private hospitals in compliance with the National Health System. Multivariate logistic regression analyses were performed to identify factors associated with mortality and complications, and negative binomial models for the mean hospital length of stay (LoS). Standardized rates were used to discriminate both the effectiveness and safety among regions with higher and lower levels of implementation of the technique using the national median as the threshold, (37 implants x 105 habitants) in the 4-year period. Results: A total of 5454 TAVIs were analyzed. The in-hospital mortality rate dropped from 4.89% in 2014 to 2.7% in 2017. The LoS decreased from 13.1 days in 2014 to 11.3 days in 2017. No differences in mortality were observed among the regions. However, the LoS of regions with a high volume of implants was significantly lower (OR, 0.88; 95%CI, 0.86-0.91; P < .01), as well as the risk of infections (OR, 0.54; 95%CI, 0.32-0.9; P = .02), and pacemaker implantation (OR, 0.77; 95%CI, 0.65-0.91; P < .01). Conclusions: The use of TAVI in Spain is safe and has grown progressively with improved outcomes regarding morbidity and mortality. Differences among regions have been highlighted regarding patient access to TAVI. This heterogeneity was not associated with mortality but with differences in the morbidity rates. Introducción y objetivos: El implante percutáneo de válvula aórtica (TAVI) se ha consolidado como tratamiento de la estenosis aórtica grave. Como toda intervención, su seguridad y su efectividad deben monitorizarse en condiciones de práctica real. Para ello, se han analizado los datos del Sistema Nacional de Salud disponibles entre los años 2014 y 2017. Métodos: Se evaluaron todos los pacientes mayores de 50 años con TAVI por vía transfemoral incluidos en el Registro de Actividad de Atención Especializada entre 2014 y 2017 procedentes de centros públicos o concertados. Se hicieron análisis de regresión logísticos par