Key result
Transcatheter aortic valve replacement in the Gulf region resulted in a one-year death or rehospitalization rate of 12.8% (95% CI 10.6-15.4), primarily driven by heart failure admissions.
Why the study?
The use of TAVR is steadily increasing across the surgical risk spectrum, but registry data detailing demographics, comorbidities, procedural success, complications, and 1-year outcomes in the Gulf region were needed.
Cohort (n=795)
Yes
In a Gulf region registry, TAVR demonstrated high procedural success and low complication rates, with one-year outcomes primarily driven by heart failure rehospitalizations and pacemaker implantations.
TAVR outcomes in Gulf registry patients appear acceptable yet HF-driven; extends real-world data to this region but leaves open need for prospective confirmation.
BACKGROUND: The use of transcatheter aortic valve replacement (TAVR) is steadily increasing with TAVR procedures offered to patients across the entire spectrum of surgical risks. The Gulf TAVR registry captures the demographics of patients undergoing TAVR in the Gulf region, comorbidities that drive outcomes, procedural success, complications, and one-year outcomes of death or rehospitalization. METHODS: This is a retrospective cohort study for adult patients aged at least 18 years undergoing TAVR at eight centers in the Gulf region. The primary outcome was a composite of death or re-hospitalization at one-year. Secondary outcomes included the individual components of the composite, stroke, and myocardial infarction (MI). We used multivariable Cox regression to determine factors associated with the composite endpoint. RESULTS: A total of 795 patients (56% male) were included in the final analysis with a mean age of 74.6 (standard deviation (SD) 8.9) years, Society of Thoracic Surgeons Score (STS) Score 4.9 (4.2), ejection fraction of 53% (12.7%). Transfemoral approach was employed in over 95% (762/795). The primary outcomes rate was 12.8% (95% confidence interval [CI]: 10.6-15.4); secondary endpoints were death 5.4% (95% CI 4.0-7.2); stroke 0.8% (95% CI 0.3, 1.7), MI 0.8% (95% CI 0.4-1.9), rehospitalization: 9.3% (95% CI 7.5-11.5) of whom 71.6% were related to cardiovascular causes. 77% of the cardiovascular admissions were attributable to heart failure or the need for pacemaker implantation. Stage IV or V chronic kidney disease was significantly associated with the primary composite endpoint (Hazard Ratio: 2.49, [95% CI: 1.31, 4.73], p = 0.005). Although not significant, paravalvular leak and severe left ventricular dysfunction showed a 2-fold and 3-fold increased risk for the composite endpoint, respectively. CONCLUSIONS: The Gulf TAVR registry is the first of its kind in the region. It profiles an elderly population with a high procedural success rate and a low rate of complications. One-year outcomes were primarily driven by repeat hospitalization for heart failure and pacemaker implantation indicating a need to optimize heart failure management and improve algorithms for the detection of conduction abnormalities.
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Alasnag et al. (2021) conducted a cohort in Aortic valve disease requiring TAVR (n=795). Transcatheter aortic valve replacement (TAVR) was evaluated on Composite of death or re-hospitalization at one-year (95% CI 10.6-15.4). Transcatheter aortic valve replacement in the Gulf region resulted in a one-year death or rehospitalization rate of 12.8% (95% CI 10.6-15.4), primarily driven by heart failure admissions.
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