| Abstract [eng] |
Introduction. Even though the global numbers of transcatheter aortic valve implantation (TAVI) increase yearly, the ageing population and expanding indications create the demand for TAVI, which is still unmet. Patients with diagnosed symptomatic severe aortic valve stenosis have a poor prognosis and increased mortality while being on the waiting list for aortic valve replacement therapy. This study aimed to evaluate the changes in TAVI waiting times from 2009 to 2024 in a tertiary centre and possible sociodemographic and health condition predictors of waiting times. Methods. Retrospective single-centre analysis included TAVI cases (n=806) between 2009 and 2024. The primary outcome was total waiting time from the ultrasound diagnosis of severe aortic stenosis and documented indication for valve replacement. Secondary outcomes were evaluation waiting time (from diagnosis to the last pre-TAVI evaluation test) and procedural waiting time (from the last test to TAVI). For inferential analyses, Kruskal-Wallis and Mann-Whitney U tests were used for quantitative variables, and Chi-square and Fisher-Freeman-Halton Exact tests were used for categorical data. Predictors were modelled with logistic regression. Results. 806 cases were analysed, of which 64.89 % were female and 85.36 % were 75 years or older. The total waiting time was a median of 189.5 days in 2009 – 2024 and a median of 173 days in 2021 – 2024. The evaluation waiting time was 62.5 days in 2009-2024 and 49 days in 2021-2024. The procedural waiting time was 78.5 days in 2009-2024 and 89.5 days in 2021-2024. In 2021, procedural waiting time surpassed evaluation waiting time, 70 and 66 days, respectively. In 2021-2024, total waiting time was shorter in patients with left ventricular ejection fraction below 30 % (58 days, p <0.001), previous history of aortic valve surgery (p = 0.028), non-elective group (36 days, p < 0.001), previous myocardial infarction (145 days, p = 0,005), male patients (153 days, p = 0.015). Logistic regression showed age (OR 0.96; CI [0.929; 0.997]), year (OR 0.31; CI [0.176; 0.550] for 2022; OR 0.35; [0.2; 0.621] for 2023), non-elective TAVI (OR 0.09; CI [0.046; 0.189]), reason groups (OR 3.6; CI [1.972; 6.555] for health-related; OR 28.94; CI [10.815; 77.451] for personal reasons) to be significant predictors of waiting. Conclusion. From 2021 to 2024, there was a trend of increasing total waiting time, driven by a growth in procedural waiting time, with total waiting time exceeding those described in the literature. Age, year, urgency, reasons for delay, and multiple other clinical factors appear to be important predictors of waiting times. |
