2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry Frederick L. Grover, MD, Sreekanth.

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2016 Annual Report of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry Frederick L. Grover, MD, Sreekanth Vemulapalli, MD, John D. Carroll, MD, Fred H. Edwards, MD, Michael J. Mack, MD, Vinod H. Thourani, MD, Ralph G. Brindis, MD, MPH, David M. Shahian, MD, Carlos E. Ruiz, MD, Jeffrey P. Jacobs, MD, George Hanzel, MD, Joseph E. Bavaria, MD, E. Murat Tuzcu, MD, Eric D. Peterson, MD, MPH, Susan Fitzgerald, RN, MS, Matina Kourtis, MS, Joan Michaels, RN, MSN, Barbara Christensen, MSHA, RN, William F. Seward, MA, Kathleen Hewitt, MSN, RN, David R. Holmes, MD The Annals of Thoracic Surgery Volume 103, Issue 3, Pages 1021-1035 (March 2017) DOI: 10.1016/j.athoracsur.2016.12.001 Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 1 Site and procedure counts for TAVR. Note that there has been progressive increase annually, with a total of 418 sites that have performed 54,782 transcatheter aortic valve replacement (TAVR) procedures. (TVTR = Transcatheter Valve Therapy Registry.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 2 Site and procedure counts for the mitral clip procedure. Note the progressive increase since 2013 to a total of 176 sites that have performed 3,745 mitral clip procedures. (TVTR = Transcatheter Valve Therapy Registry.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 3 Site and procedure counts for transcatheter mitral valve-in-valve and valve-in-ring procedures. Note the annual increases beginning in 2013 for an overall 98 sites that have performed the 349 mitral valve-in-valve and valve-in-ring procedures through December 31, 2015. (TMVR = transcatheter mitral valve repair; TVTR = Transcatheter Valve Therapy Registry.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 4 Map of TAVR sites color coded by year of their first TAVR. Blue = 2011, green = 2012, yellow = 2013, orange = 2014, and red = 2015. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 5 The age of TAVR patients by age categories each year from 2012 through 2015. Note that the predominate age group is still ≥80 years, although there has been some decrease recently in the older age groups, likely reflecting the somewhat lower-risk patient population. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 6 In-hospital and 30-day mortality rates of TAVR patients. Note the progressive decrease in mortality from 2012 to 2015. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 7 1-Year mortality and stroke rate using TVT/CMS linkage. Note the decreasing mortality over 3 years whereas the stroke rate did not significantly change. (CMS = U.S. Centers for Medicare & Medicaid Services; TVT = transcatheter valve therapy.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 8 Significant reduction in major TAVR post-procedure bleeding and vascular injuries. A very significant reduction in bleeding is noted over time. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 9 Severity of aortic regurgitation at discharge and 30 days following TAVR. Note the decrease in severity of aortic regurgitation over 4 years. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Fig 10 Post-TAVR aortic valve gradients. A significant increase in the <10-mm Hg category, and consistent decreases in the 10- to <20-mm Hg and ≥20-mm Hg categories are demonstrated over 4 years. (TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions

Central Illustration Timeline indicating the FDA approval of various transcatheter valvular devices. Note the approval by year beginning from the inception of the Transcatheter Valve Therapy Registry in 2011 through December 31, 2015. (FDA = U.S. Food and Drug Administration; TAVR = transcatheter aortic valve replacement.) The Annals of Thoracic Surgery 2017 103, 1021-1035DOI: (10.1016/j.athoracsur.2016.12.001) Copyright © 2017 The Society of Thoracic Surgeons and the American College of Cardiology Foundation Terms and Conditions