Temporal trends and long-term clinical outcomes of transcatheter aortic valve implantation.

Progress in transcatheter aortic valve implantation (TAVI) devices has been remarkable. Although the indications for TAVI have expanded to younger or lower-risk patients, reports on temporal trends are scarce. This study aimed to investigate temporal trends in the patient cohort and clinical outcomes of TAVI between 2013 and 2025 at a high-volume center. We included 2,000 consecutive patients who underwent TAVI between 2013 and 2025. Patient characteristics, periprocedural outcomes, and long-term all-cause mortality rates were analyzed. Over 12 years, annual TAVI volumes have increased approximately fourfold, from 73 in 2013 to 275 in 2024. Although the surgical risk estimated by the Society of Thoracic Surgeons score remained high in 2024, the 30-day mortality rate remained low (2013: 2.8%; 2024: 0.4%; p = 0.112), and was notably low among patients at low risk (0.2%) and at intermediate risk (0.1%). The incidence of periprocedural bleeding decreased (2013: 8.3%; 2024: 2.5%; p = 0.004), and other safety outcomes showed no significant differences, remaining low throughout the study period. During a median follow-up of 891 (interquartile range: 363–1705) days, mortality rate at 10 years after TAVI was 83.8%, with paravalvular leakage ≥mild identified as an independent risk factor. In conclusion, from 2013 to 2025, the case volume significantly increased. Regardless of the risk profile, mortality and procedural complications following TAVI remained low. The advantages of TAVI will be maximized not only through device advancements but also through the operator skill and patient management by the Heart Team.