Patterns of Postdischarge Heart Failure, Ischemic, and Bleeding Events After Transcatheter Aortic Valve Replacement

Although outcomes after transcatheter aortic valve replacement (TAVR) have improved, heart failure (HF) hospitalization, ischemic events, and major bleeding remain clinical challenges in patients with severe aortic stenosis. The objective of the study was to evaluate the incidence, timing, and prognostic impact of these events after TAVR. This two-center retrospective registry included 988 patients with severe aortic stenosis who underwent TAVR. Patients were grouped according to the first clinical event after discharge: HF hospitalization, ischemic events (myocardial infarction or ischemic stroke), major bleeding, or the event-free group. The timing of the first postdischarge event and all-cause mortality after the first event were evaluated. During a median follow-up of 665 days after discharge, 165 patients (16.7%) experienced any of these events. As first events, HF hospitalization, ischemic events, and major bleeding occurred in 80 (8.1%), 32 (3.2%), and 53 (5.4%) patients, respectively, whereas 823 (83.3%) were in the event-free group. Among patients with a first postdischarge event, major bleeding occurred earliest among the 3 event groups. One-year all-cause mortality after the first event was high across groups (HF hospitalization, 31.5%; ischemic events, 30.4%; major bleeding, 25.4%). Among patients who experienced a first postdischarge event after TAVR, major bleeding occurred earlier than HF hospitalization or ischemic events. Once a first postdischarge event occurred, subsequent all-cause mortality was high across the 3 event groups. These findings suggest that event timing should be considered and careful clinical reassessment may be warranted when a first postdischarge event occurs after TAVR.