OBJECTIVES: Transcatheter aortic valve implantation (TAVI), a less invasive but more costly alternative to surgical aortic valve replacement, is increasingly being performed and was recommended for subsidy in patients with inoperable or unacceptably high surgical risk in September 2021. As part of an ongoing study to evaluate the impact of subsidies on utilization and outcomes, we aim to assess the changes in characteristics of patients receiving TAVI.

METHODS: A nationwide observational study was conducted using data submitted by public healthcare institutions from April 2021 to April 2022. Characteristics of patients who underwent TAVI pre- and post-subsidy were compared using chi-square test and Student’s t-test for categorical and continuous variables respectively.

RESULTS: 57 and 55 patients who underwent TAVI pre- and post-subsidy respectively were included in the analysis. Mean age of patients (77.4±9.0 years) remained stable post-subsidy (p=0.94). Based on a Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) score of less than 4%, there were more patients with low surgical risk post-subsidy (74.1%) than pre-subsidy (47.9%; p=0.01). Among all patients in the post-subsidy period, 15% (n=8) were assessed by the multidisciplinary heart team to be inoperable or have an unacceptably high surgical risk, and received subsidies which reduced their average implant cost by 76%. The mean STS-PROM score of these 8 eligible patients was 5.6±2.8% which was not considered high risk (>8%). No significant differences pre- and post-subsidy were observed for obesity, gender, and race.

CONCLUSIONS: Consistent with global findings, there is a shift towards TAVI use in lower risk groups, likely contributed by clinician and patient preference. This interim analysis also suggested that STS-PROM score may not adequately reflect the overall surgical risk assessed by the multidisciplinary heart team, highlighting the need to consider other important clinical and anatomical variables in Asian patients undergoing TAVI.