Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry

Dhaval Kolte, Sahil Khera, Sreekanth Vemulapalli, Dadi Dai, Stephan Heo, Andrew M. Goldsweig, Herbert D. Aronow, Sammy Elmariah, Ignacio Inglessis, Igor F. Palacios, Vinod H. Thourani, Barry L. Sharaf, Paul C. Gordon, J. Dawn Abbott

Research output: Contribution to journalArticlepeer-review

40 Scopus citations

Abstract

Objectives: The authors sought to examine outcomes and identify independent predictors of mortality among patients undergoing urgent/emergent transcatheter aortic valve replacement (TAVR). Background: Data on urgent/emergent TAVR as a rescue therapy for decompensated severe aortic stenosis (AS) are limited. Methods: The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry linked with Centers for Medicare & Medicaid Services claims was used to identify patients who underwent urgent/emergent versus elective TAVR between November 2011 and June 2016. Outcomes assessed were device success rate, in-hospital major adverse events, and 30-day and 1-year mortality. Independent predictors of mortality after urgent/emergent TAVR were examined. Results: Of 40,042 patients who underwent TAVR, 3,952 (9.9%) were urgent/emergent (median STS PROM score 11.8 [interquartile range: 7.6 to 17.9]). Device success rate was statistically lower, but not clinically different after urgent/emergent versus elective TAVR (92.6% vs. 93.7%; p = 0.007). Rates of major and/or life-threatening bleeding, major vascular complications, myocardial infarction, stroke, new permanent pacemaker placement, conversion to SAVR, and paravalvular regurgitation were similar between the 2 groups. Compared with elective TAVR, patients undergoing urgent/emergent TAVR had higher rates of acute kidney injury and/or new dialysis (8.2% vs. 4.2%; p < 0.001), 30-day mortality (8.7% vs. 4.3%, adjusted hazard ratio: 1.28, 95% confidence interval: 1.10 to 1.48), and 1-year mortality (29.1% vs. 17.5%, adjusted hazard ratio: 1.20, 95% confidence interval: 1.10 to 1.31). In patients undergoing urgent/emergent TAVR, non-femoral access and cardiopulmonary bypass were associated with increased risk, whereas use of balloon-expandable valve was associated with decreased risk of 30-day and 1-year mortality. Conclusions: Urgent/emergent TAVR is feasible with acceptable outcomes and may be a reasonable option in a selected group of patients with severe AS.

Original languageEnglish (US)
Pages (from-to)1175-1185
Number of pages11
JournalJACC: Cardiovascular Interventions
Volume11
Issue number12
DOIs
StatePublished - Jun 25 2018

Keywords

  • aortic stenosis
  • cardiogenic shock
  • heart failure
  • mortality
  • transcatheter aortic valve implantation
  • transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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