Key result
Implantation of a second rescue valve during TAVI was associated with a 30-day mortality of 15.2%, compared to 1.6% in patients receiving a single valve.
Why the study?
Uncommon complications during TAVI such as valve malposition require implantation of an additional rescue valve, but its occurrence and outcomes warranted nationwide study.
Does the need for a second rescue valve during TAVI affect 30-day mortality and long-term survival compared to single valve implantation?
Cohort (n=5,948)
Yes
Does the need for a second rescue valve during TAVI affect 30-day mortality and long-term survival compared to single valve implantation?
Although requiring a rescue valve during TAVI is rare (1.3%) and carries a high 30-day mortality risk, patients who survive the first 30 days have long-term outcomes similar to those with uncomplicated procedures.
High early mortality after rescue-AV warrants procedural vigilance; leaves open modifiable risk factors in observational TAVI data.
Background: Transcatheter aortic valve implantation (TAVI) has become a safe procedure. However, complications occur, including uncommon complications such as valve malposition, which requires the implantation of an additional rescue valve (rescue-AV). The aim was to study the occurrence and outcomes of rescue-AV in a nationwide registry. Methods: The Swedish national TAVI registry was used as the primary data source, where all 6706 TAVI procedures from 2016 to 2021 were retrieved. Nontransfemoral access and planned valve-in-valve were excluded. In total, 79 patients were identified as having had a rescue-AV, and additional detailed data were collected for these patients. This dataset was analyzed for any characteristics that could predispose patients to a rescue-AV. The outcome of patients receiving rescue-AV also was studied. Results: Of the 5948 patients in the study, 1.3% had a rescue-AV. There were few differences between patients receiving 1 valve and rescue-AV patients. For patients receiving a rescue-AV, the 30-day mortality was 15.2% compared to 1.6% in the control group. A poor outcome after rescue-AV was often associated with a second complication; for example, stroke, need for emergency surgery, or heart failure. Among the patients with rescue-AV who survived at least 30 days, landmark analyses showed similar survival rates compared to the control group. Conclusions: Among TAVI patients in a nationwide register, rescue-AV occurred in 1.3% of patients. The 30-day mortality in patients receiving rescue-AV was high, but long-term outcome among 30-day survivors was similar to the control group.
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Bjursten et al. (2023) conducted a cohort in Transcatheter aortic valve implantation (TAVI) (n=5,948). Second rescue valve (rescue-AV) vs. Single valve (control group) was evaluated on 30-day mortality. Implantation of a second rescue valve during TAVI was associated with a 30-day mortality of 15.2%, compared to 1.6% in patients receiving a single valve.
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