Short-Term and Long-Term Outcomes of Patients Undergoing Urgent Transcatheter Aortic Valve Replacement Under a Minimalist Strategy.

Abstract

OBJECTIVES:

Urgent transcatheter aortic valve replacement (TAVR) is associated with worse short-term outcomes compared with elective TAVR; however, little is known about long-term outcomes or the safety of the minimalist strategy in this setting. This study investigated the short-term and long-term outcomes of urgent TAVR compared with elective TAVR under a minimalist strategy (transfemoral [TF] approach with conscious sedation and no transesophageal echocardiography guidance).

METHODS:

After excluding 2 emergent patients requiring immediate procedures, a total of 474 consecutive patients underwent elective TF-TAVR (396 patients; 83.6%) or urgent TF-TAVR (78 patients; 16.4%). Urgent TAVR was defined as a procedure performed in the same hospitalization in patients emergently admitted due to cardiac arrest, severe acute decompensated heart failure, acute coronary syndrome, or repeated syncopal episodes.

RESULTS:

A minimalist approach was used in 77 patients (98.7%) undergoing urgent TAVR and in 392 patients (99.0%) undergoing elective TAVR (P=.59). Urgent TAVR had similar procedure-related complications, such as stroke, myocardial infarction, bleeding or vascular complications, and in-hospital mortality compared with elective TAVR (mortality, 1.3% vs 0.8%; P=.51) with no intraprocedural cross-over from conscious sedation to general anesthesia. However, 30-day and 1-year survival rates were reduced in patients undergoing urgent TAVR. After adjustment with baseline and procedural factors, urgent TAVR remained significantly predictive of 1-year mortality (adjusted hazard ratio, 2.26; 95% confidence interval, 1.16-4.23; P=.01).

CONCLUSIONS:

Urgent minimalist TAVR can be safely performed with favorable in-hospital outcomes, while increased 30-day and 1-year mortality rates suggest the importance of appropriate diagnosis and timely treatment of severe aortic stenosis.

• Authors: Yasuhiro Ichibori, Jun Li, Toral Patel, Jerry Lipinski, Thomas Ladas, Petar Saric, Daniel Kobe, Takahiro Tsushima, Matthew Peters, Sandeep Patel, Angela Davis, Alan H Markowitz, Hiram G Bezerra, Marco A Costa, Ankur Kalra, Guilherme F Attizzani
• Journal: The Journal of invasive cardiology (J Invasive Cardiol) Vol. 31 Issue 2 Pg. E30-E36 (02 2019) ISSN: 1557-2501 [Electronic] United States
• PMID: 30700628 (Publication Type: Journal Article)

Topics

• Aged, 80 and over
• Aortic Valve (diagnostic imaging, surgery)
• Aortic Valve Stenosis (diagnosis, mortality, surgery)
• Cardiac Catheterization (methods)
• Echocardiography, Transesophageal
• Elective Surgical Procedures (methods)
• Female
• Femoral Artery
• Follow-Up Studies
• Hospital Mortality (trends)
• Humans
• Length of Stay
• Male
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Time Factors
• Transcatheter Aortic Valve Replacement (methods)
• Treatment Outcome
• United States (epidemiology)