Background—Trans-catheter aortic valve replacement (TAVR) represents a paradigm shift in the therapeutic options for patients with severe aortic stenosis. However, rapid and exponential growth in TAVR demand may overwhelm capacity, translating to inadequate access and prolonged wait-times. Our objective was to evaluate temporal trends in TAVR wait-times and the associated clinical consequences.Methods—In this population-based study in Ontario, Canada, we identified all TAVR referrals from April 1st, 2010 to March 31st, 2016. The primary outcome was the median total wait-time from referral to procedure. Piecewise regression analyses were performed to assess temporal trends in TAVR wait-times, before and after provincial reimbursement in September 2012. Clinical outcomes included all-cause death and heart failure hospitalizations while on the wait-list.Results—The study cohort included 4,461 referrals, of which 50% led to a TAVR, 39% were off-listed for other reasons and 11% remained on the wait-list at the conclusion of the study. For patients who underwent a TAVR, the estimated median wait-time in the post-reimbursement period stabilized at 80 days and has remained unchanged. The cumulative probability of wait-list mortality and heart failure hospitalization at 80 days was approximately 2% and 12% respectively, with a relatively constant increase in events with increased wait-times.Conclusions—Post-reimbursement wait-time has remained unchanged for patients undergoing a TAVR procedure, suggesting the increase in capacity has kept pace with the increase in demand. The current wait-time of almost 3 months is associated with important morbidity and mortality, suggesting a need for greater capacity and access.

背景—经导管主动脉瓣置换术（TAVR）代表重度主动脉瓣狭窄患者治疗选择的范式转变。但是，TAVR需求的快速增长和指数增长可能使容量不堪重负，从而导致访问不足和等待时间延长。我们的目标是评估TAVR等待时间的时间趋势以及相关的临床后果。方法—在加拿大安大略省的这项基于人群的研究中，我们确定了从2010年4月1日到2016年3月31日的所有TAVR转诊。主要结局是从转诊到手术的总等待时间中位数。在2012年9月省级补偿之前和之后，进行了分段回归分析以评估TAVR等待时间的时间趋势。临床结果包括在等待名单上的全因死亡和心力衰竭住院。结果—该研究队列包括4,461例转诊，其中50％导致了TAVR，39％因其他原因被除名，而11％在研究结束时仍在候补名单上。对于接受TAVR的患者，报销后期间的估计中位等待时间稳定在80天，并且保持不变。80天的等待名单死亡率和心力衰竭住院的累积概率分别约为2％和12％，随着等待时间的增加，事件的发生率相对恒定。结论-接受TAVR手术的患者的报销后等待时间保持不变，这表明容量的增加与需求的增加保持同步。当前的等待时间将近3个月，这与重要的发病率和死亡率相关，这表明需要更大的容量和使用率。