Key result
TAVI for acute decompensated AS is linked to ~5-fold higher 30-day mortality versus elective TAVI.
Why the study?
Acute decompensated aortic stenosis is often treated medically or with balloon aortic valvuloplasty as a temporizing measure resulting in suboptimal outcomes, whereas first-line TAVI offers an alternative option whose safety and efficacy required assessment.
Does TAVI for acute decompensated aortic stenosis have similar procedural and 30-day mortality compared to elective TAVI?
Cohort (n=893)
Does TAVI for acute decompensated aortic stenosis have similar procedural and 30-day mortality compared to elective TAVI?
Absolute Event Rate: 5.3% vs 1.1%
p-value: p=.002
TAVI for acute decompensated aortic stenosis is safe and has similar procedural mortality to elective TAVI, though 30-day mortality and length of stay are higher due to worse baseline physiological status.
TAVI in ADAS yields procedural mortality similar to elective cases yet higher 30-day risk and longer stays; leaves open whether first-line use improves net outcomes versus alternatives.
OBJECTIVES: To assess the safety and efficacy of first-line transcatheter aortic valve implantation (TAVI) in patients presenting with acute decompensated aortic stenosis (ADAS). BACKGROUND: ADAS is common and is often treated medically or using balloon aortic valvuloplasty in the first instance. This temporizing measure results in suboptimal outcomes. In the current era, TAVI provides an alternative option. METHODS: Consecutive patients who had either a TAVI for ADAS or electively were included in the study. The primary outcome was procedural and 30-day mortality and hospital length of stay (LOS). Secondary outcomes included 1-year mortality and procedural complications. RESULTS: Of note, 893 patients (mean age 83 ± 7, 50.5% male) underwent TAVI (19% ADAS, 81% elective). ADAS patients were more unwell with worse echocardiographic parameters than elective patients. ADAS patients of 55.9% were known to have significant aortic stenosis prior to their decompensation. Procedural mortality was not different between the ADAS and elective cohorts (1.2 vs. 0.7%; p = .62). The ADAS cohort had a higher 30-day mortality (5.3 vs. 1.1%; p = .002) and longer LOS (31.9 ± 20.7 days vs. 6.1 ± 6.5 days; p < .001). Multivariate analysis identified acute kidney injury and ADAS as significant predictors of 30-day mortality. CONCLUSIONS: TAVI for ADAS is safe and effective with procedural outcomes similar to elective patients. However, compared to elective patients, they have worse physiological baseline features, poorer prognosis at 30 days, and longer hospital admissions. Majority of patients who presented with ADAS were known to have AS prior to admission.
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Patel et al. (2019) conducted a cohort in Acute decompensated aortic stenosis (n=893). TAVI for acute decompensated aortic stenosis vs. Elective TAVI was evaluated on Procedural and 30-day mortality and hospital length of stay (LOS) (p=.002). TAVI for acute decompensated aortic stenosis had similar procedural mortality (1.2% vs 0.7%) but higher 30-day mortality (5.3% vs 1.1%, p=0.002) and longer hospital stays than elective TAVI.
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