Introduction

Transcatheter aortic valve implantation (TAVI) has transformed the treatment of severe aortic stenosis.

Aim

To investigate the association of TAVI introduction on institutional volume and characteristics of patients treated for aortic stenosis either by surgical aortic valve replacement (SAVR) or TAVI.

Material and methods

A single-centre retrospective observational study of consecutive patients treated only with SAVR (SAVR-only period, 2004-2017) and with either SAVR or TAVI (SAVR + TAVI period, 2017–2025).

Results

During the SAVR-only period, 1011 patients underwent SAVR, and during the SAVR + TAVI period, 685 patients underwent SAVR and 824 underwent TAVI. The total number of aortic valve interventions increased annually by 9% (95% CI: 1.08–1.10; p < 0.001), while SAVR decreased by 15% during the SAVR + TAVI period (95% CI: 0.82–0.89; p < 0.001). Cumulative 30-day mortality was 2.8% during the SAVR-only period and 1.5% during the SAVR + TAVI period (p = 0.021). Patients undergoing SAVR during the SAVR + TAVI period were younger (68 vs. 70 years; p < 0.001), had a lower Logistic EuroSCORE (4.52 vs. 6.33; p < 0.001) and less often underwent concomitant revascularization (29% vs. 35%; p = 0.013). Patients undergoing TAVI compared to SAVR were older (80 vs. 68 years; p < 0.001), had a higher Logistic EuroSCORE (11.39 vs. 4.52; p < 0.001), and had comparable 30-day mortality (1.0% vs. 2.0%; p = 0.083). The difference in 5-year mortality in favour of SAVR (13.8% vs. 27.4%) was not significant after adjustment for age, sex and Logistic EuroSCORE (HR = 0.794; 95% CI: 0.550–1.147; p = 0.22).

Conclusions

Introduction of TAVI was associated with increased institutional volume of aortic valve interventions despite a concomitant decrease in the number of SAVR procedures. TAVI appears to have expanded treatment to previously undertreated high-risk elderly patients while also being used in a sizable proportion of patients who previously underwent SAVR.