Association between delayed transcatheter aortic valve replacement beyond 6 months and clinical outcomes in severe aortic stenosis: a retrospective observational study

OBJECTIVE: Early intervention for asymptomatic severe aortic stenosis (AS) has shown prognostic benefits; however, some patients undergo transcatheter aortic valve replacement (TAVR) after extended observation owing to mild symptoms or comorbidities. Although guidelines recommend surveillance of 6-12 months, the clinical implications of waiting beyond 6 months remain unclear. We assessed whether TAVR performed >6 months after the diagnosis of severe AS was associated with adverse outcomes. METHODS: We retrospectively analysed 149 patients who underwent TAVR for severe AS between January 2021 and December 2023. Patients were classified into early (≤6 months; n=100) and delayed (>6 months; n=49) groups. The primary endpoint was heart failure (HF) hospitalisation or all-cause mortality. RESULTS: Baseline characteristics were similar between the groups. During a median follow-up of 729 days, the primary endpoint occurred more frequently in the delayed group than in the early group (33% vs 16%, p=0.0134). This excess risk was largely attributable to non-cardiac mortality. In multivariable Cox regression, delayed intervention was independently associated with the primary endpoint (HR 3.47, 95% CI 1.61 to 7.47; p=0.0014); higher Clinical Frailty Scale scores were also associated with this endpoint (HR 1.62, 95% CI 1.07 to 2.42; p=0.0195). CONCLUSIONS: TAVR performed 6 months after severe AS diagnosis was associated with a higher risk of HF hospitalisation or all-cause mortality, with the excess risk predominantly attributable to non-cardiac mortality. These findings emphasise the need for careful clinical surveillance and may support more frequent reassessment in selected high-risk patients.