Longitudinal Trends and Outcomes in Transcatheter Aortic Valve Implantation: a report from the SwissTAVI Registry.

The progressive expansion of indications for Transcatheter Aortic Valve Implantation (TAVI) towards lower-risk and younger populations has raised concerns about potential outcome attenuation with increasing procedural volumes. Real-world evidence addressing this concern is limited. To assess temporal trends in patient characteristics and procedural outcomes of TAVI in a large nationwide cohort. The Swiss TAVI Registry prospectively enrolled consecutive patients undergoing TAVI in Switzerland. Baseline characteristics, procedural complications and outcomes were compared across three periods: 2011-2015, 2016-2020 and 2021-2024. The primary endpoint was major adverse cardiovascular events (MACE: all-cause mortality, non-fatal myocardial infarction, and non-fatal stroke) at one year. The secondary endpoint was 30-day MACE. Among 19'452 patients, TAVI volume increased 27% annually. Patient age (82 years) and comorbidity burden remained stable, while the proportion of women increased (51% to 58%) and the median STS score decreased (4.5% to 3.3%). Considering the expansion to lower-risk patients, 1-year MACE declined significantly from 16% to 14% to 9.1% across periods (adjusted HR 0.69, 95% CI 0.62-0.78, p<0.001). Similarly, 30-day MACE decreased from 6.9% to 5.2% to 4.0% (adjusted HR 0.66, 95%CI 0.55-0.78, p<0.001). Procedural mortality declined from 2.9% to 1.2%, periprocedural myocardial infarction from 0.4% to 0.2% and stroke from 3.2% to 2.0% (all p<0.001).Risk-adjusted TAVI outcomes improved continuously despite a significant volume increase, with improvements exceeding those expected from lower-risk patients risk profiles alone.