Transcatheter aortic valve implantation for severe aortic stenosis in the Australian regional population

Objective: To compare clinical and functional outcomes of regional and urban pa-tients after transcatheter aortic valve implantation for severe aortic stenosis.Methods: Data were collected at patient follow- up post- transcatheter aortic valve implantation at 30 days and 12 months. Patients were stratified by residential post-codes into remoteness areas using the Australian Statistical Geography Standard.Design: Retrospective cohort study.Setting: Single- centre tertiary referral hospital.Participants: Patients undergoing transcatheter aortic valve implantation (n = 142) from 2009 to 2018 were analysed, with 77 patients (54.2%) residing in regional Victoria and New South Wales.Main outcome measures: Procedural success, adverse event rates, readmission rates, mortality rates, loss to follow- up and functional improvement.Results: Patients residing in regional areas had a lower mean age (81.8 vs 83.7 years) and proportion of Stage 4 or 5 chronic kidney disease (1.3% vs 9.2%), compared with urban patients. Procedural characteristics and immediate post- procedural outcomes were similar between both groups. There was no statistically significant difference in mortality, readmission rates or loss to follow- up between the two cohorts. Regional pa-tients demonstrated poorer rates of functional improvement at 30 days (50.7% vs 67.7%); however, this difference was not sustained at 12 months (79.2% vs 71.0%). Frailty was demonstrated to be an independent predictor of poor 30- day functional improvement.Conclusion: Regional patients treated with transcatheter aortic valve implantation for severe aortic stenosis have non- inferior 30- day and 12- month outcomes, when compared with urban patients. Frailty is a predictor of poor functional improvement post- transcatheter aortic valve implantation.