Background:   Transcatheter aortic valve implantation (TAVI)  is an established treatment for severe aortic stenosis .  While reimbursement policies significantly  expand  access, the impact of Taiwan's National Health Insurance (NHI) coverage introduced in February 2021 on patient characteristics and outcomes remains unclear. This study evaluates changes in patient profiles, and clinical outcomes before and after NHI reimbursement.

Methods :   We analyzed 467 patients undergoing TAVI at a high-volume tertiary center between May 2010 and April 2024. Patients were divided into pre-reimbursement (n=258) and post-reimbursement (n=209) groups.  P atient profiles , procedural variables, and clinical outcomes ,  including 30-day complications and 1-year all-cause mortality, cardiovascular death, and  rehospitalization  for  heart failure (HF) ,  were compared. Risk was stratified using the Society of Thoracic Surgeons (STS) score.

Results: Reimbursement was associated with a shift toward higher-risk patients, reflected by an increase in median STS scores (5.9% to 7.2%, p=0.002) and more patients classified as high-risk (44.0% vs. 31.8%, p=0.019). Post-reimbursement patients had higher frequency of dialysis (17.7% vs. 7.6%, p=0.001) and valve-in-valve procedures (8.4% vs. 2.7%, p=0.007), but shorter hospital stays (7.0 vs. 10.0 days, p<0.001). VARC-3 defined thirty-day outcomes were similar, except for reduced acute kidney injury in post-reimbursement patients (1.0% vs. 6.6%, p=0.021). One-year mortality was unchanged, but HF rehospitalization decreased significantly (2.9% vs. 8.1%, p=0.017). After multivariable adjustment, high STS risk (≥8%) independently predicted worse one-year outcomes.

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Conclusion: NHI reimbursement in Taiwan expanded TAVI access to higher-risk patients without compromising short- or mid-term mortality, and was associated with improved heart failure readmission, especially among high-risk patients.