Key result
Expedited TAVR was associated with a significantly higher risk of in-hospital mortality (5.6% vs 1.4%; OR 4.07, p=0.001) and 3-year mortality (HR 1.69, p=0.001) compared to elective TAVR.
Why the study?
Patients with rapidly deteriorating clinical status due to severe aortic stenosis are often referred for expedited TAVR, but data regarding the outcomes of such interventions are limited.
Does expedited TAVR compared to elective TAVR worsen short- and long-term mortality in patients with severe aortic stenosis?
Cohort (n=3,282)
Yes
Does expedited TAVR compared to elective TAVR worsen short- and long-term mortality in patients with severe aortic stenosis?
Expedited TAVR in patients with rapidly deteriorating severe aortic stenosis is associated with significantly higher procedural complications and both short- and long-term mortality compared to elective TAVR.
Supports caution with expedited TAVR; leaves open whether randomized trials confirm higher mortality versus selection bias.
OBJECTIVE: Patients with rapidly deteriorating clinical status due to severe aortic stenosis are often referred for expedited transcatheter aortic valve replacement (TAVR). Data regarding the outcome of such interventions is limited. We aimed to evaluate the outcome of patients undergoing expedited TAVR. DESIGN AND SETTING: Data were derived from the Israeli Multicenter Registry. SUBJECTS: Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N = 3140) and those who had an expedited TAVR (N = 142). Procedural and periprocedural complication rates were significantly higher among patients with an expedited indication for TAVR compared to those having an elective procedure: valve malposition 4.6% versus 0.6% (p < 0.001), procedural cardiopulmonary resuscitation 4.3% versus 1.0% (p = 0.007), postprocedure myocardial infarction 2.0% versus 0.4% (p = 0.002), and stage 3 acute kidney injury 3.0% versus 1.1%, (p < 0.001). Patients with expedited indication for TAVR had significantly higher in hospital mortality (5.6% vs. 1.4%, p = 0.003). Kaplan-Meier's survival analysis showed that patients undergoing expedited TAVR had higher 3-year mortality rates compared to patients undergoing an elective TAVR procedure (p < 0.001). Multivariate analysis found that patients with expedited indication had fourfolds increased risk of in-hospital mortality (odds ratio: 4.07, p = 0.001), and nearly twofolds increased risk of mortality at 3-year (hazard ratio: 1.69, p = 0.001) compared to those having an elective procedure. CONCLUSION: Patients with expedited indications for TAVR suffer from poor short- and long-term outcomes. It is important to characterize and identify these patients before the deterioration to perform TAVR in a fast-track pathway to minimize their procedural risk.
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Berkovitch et al. (2022) conducted a cohort in Severe aortic stenosis (n=3,282). Expedited transcatheter aortic valve replacement (TAVR) vs. Elective TAVR was evaluated on In-hospital mortality (OR 4.07, p=0.001). Expedited TAVR was associated with a significantly higher risk of in-hospital mortality (5.6% vs 1.4%; OR 4.07, p=0.001) and 3-year mortality (HR 1.69, p=0.001) compared to elective TAVR.
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