Outcomes of Adults with Severe Aortic Stenosis Undergoing Urgent or Emergent Vs. Elective Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System

Overview

Journal Struct Heart

Publisher Elsevier

Specialty Cardiology & Vascular Diseases

Date 2023 Jul 31

PMID 37520133

Authors

Justin J Slade

Andrew P Ambrosy

Thomas K Leong

Sue Hee Sung

Elisha A Garcia

Ivy A Ku

Matthew D Solomon

Edward J McNulty

Andrew N Rassi

David C Lange

Femi Philip

Alan S Go

Jacob M Mishell

Affiliations

Soon will be listed here.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) may be used to urgently or emergently treat severe aortic stenosis, but outcomes for this high-risk population have not been well-characterized. We sought to describe the incidence, clinical characteristics, and outcomes of patients undergoing urgent or emergent vs. elective TAVR.

Methods: We identified all adults who received TAVR for primary aortic stenosis between 2013 and 2019 within an integrated health care delivery system in Northern California. Elective or urgent/emergent procedure status was based on standard Society of Thoracic Surgeons definitions. Data were obtained from electronic health records, the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy Registry, and state/national reporting databases. Logistic regression and Cox proportional hazard models were performed.

Results: Among 1564 eligible adults that underwent TAVR, 81 (5.2%) were classified as urgent/emergent. These patients were more likely to have heart failure (63.0% vs. 47.4%), reduced left ventricular ejection fraction (21.0% vs. 11.8%), or a prior aortic valve balloon valvuloplasty (13.6% vs. 5.0%) and experienced higher unadjusted rates of 30-day and 1-year morbidity and mortality. Urgent/emergent TAVR status was independently associated with non-improved quality of life at 30-days (hazard ratio, 4.87; < 0.01) and acute kidney injury within 1-year post-TAVR (hazard ratio, 2.11; = 0.01). There was not a significant difference in adjusted 1-year mortality with urgent/emergent TAVR.

Conclusions: Urgent/emergent TAVR status was uncommon and associated with high-risk clinical features and higher unadjusted rates of short- and long-term morbidity and mortality. Procedure status may be useful to identify patients less likely to experience significant short term improvement in health-related quality of life post-TAVR.

References

Vincent F, Ternacle J, Denimal T, Shen M, Redfors B, Delhaye C . Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve Stenosis. Circulation. 2021; 143(10):1043-1061. DOI: 10.1161/CIRCULATIONAHA.120.048048. View

Mack M, Leon M, Thourani V, Makkar R, Kodali S, Russo M . Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1695-1705. DOI: 10.1056/NEJMoa1814052. View

Krieger N . Overcoming the absence of socioeconomic data in medical records: validation and application of a census-based methodology. Am J Public Health. 1992; 82(5):703-10. PMC: 1694121. DOI: 10.2105/ajph.82.5.703. View

Kolte D, Khera S, Vemulapalli S, Dai D, Heo S, Goldsweig A . Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement: Insights From the STS/ACC TVT Registry. JACC Cardiovasc Interv. 2018; 11(12):1175-1185. DOI: 10.1016/j.jcin.2018.03.002. View

Arnold S, Zhang Y, Baron S, McAndrew T, Alu M, Kodali S . Impact of Short-Term Complications on Mortality and Quality of Life After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019; 12(4):362-369. PMC: 6392020. DOI: 10.1016/j.jcin.2018.11.008. View

Reardon M, Van Mieghem N, Popma J, Kleiman N, Sondergaard L, Mumtaz M . Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017; 376(14):1321-1331. DOI: 10.1056/NEJMoa1700456. View

Popma J, Deeb G, Yakubov S, Mumtaz M, Gada H, OHair D . Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients. N Engl J Med. 2019; 380(18):1706-1715. DOI: 10.1056/NEJMoa1816885. View

Webb J, Murdoch D, Alu M, Cheung A, Crowley A, Dvir D . 3-Year Outcomes After Valve-in-Valve Transcatheter Aortic Valve Replacement for Degenerated Bioprostheses: The PARTNER 2 Registry. J Am Coll Cardiol. 2019; 73(21):2647-2655. DOI: 10.1016/j.jacc.2019.03.483. View

Amgai B, Patel N, Chakraborty S, Bandyopadhyay D, Hajra A, Koirala S . 30-day readmission following urgent and elective transcatheter aortic valve replacement: A Nationwide Readmission Database analysis. Catheter Cardiovasc Interv. 2021; 98(7):E1026-E1032. DOI: 10.1002/ccd.29918. View

10.

Palevsky P, Liu K, Brophy P, Chawla L, Parikh C, Thakar C . KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013; 61(5):649-72. DOI: 10.1053/j.ajkd.2013.02.349. View

11.

Gordon N, Lin T . The Kaiser Permanente Northern California Adult Member Health Survey. Perm J. 2016; 20(4):15-225. PMC: 5101088. DOI: 10.7812/TPP/15-225. View

12.

Enta Y, Miyasaka M, Taguri M, Tada N, Hata M, Watanabe Y . Patients' characteristics and mortality in urgent/emergent/salvage transcatheter aortic valve replacement: insight from the OCEAN-TAVI registry. Open Heart. 2020; 7(2). PMC: 7737081. DOI: 10.1136/openhrt-2020-001467. View

13.

Bianco V, Habertheuer A, Kilic A, Aranda-Michel E, Serna-Gallegos D, Schindler J . Urgent transcatheter aortic valve replacement may be performed with acceptable long-term outcomes. J Card Surg. 2020; 36(1):206-215. DOI: 10.1111/jocs.15195. View

14.

Carroll J, Mack M, Vemulapalli S, Herrmann H, Gleason T, Hanzel G . STS-ACC TVT Registry of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol. 2020; 76(21):2492-2516. DOI: 10.1016/j.jacc.2020.09.595. View

15.

Yoon S, Bleiziffer S, De Backer O, Delgado V, Arai T, Ziegelmueller J . Outcomes in Transcatheter Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Stenosis. J Am Coll Cardiol. 2017; 69(21):2579-2589. DOI: 10.1016/j.jacc.2017.03.017. View

16.

Leon M, Smith C, Mack M, Miller D, Moses J, Svensson L . Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17):1597-607. DOI: 10.1056/NEJMoa1008232. View

17.

Deharo P, Bisson A, Herbert J, Lacour T, Saint Etienne C, Porto A . Transcatheter Valve-in-Valve Aortic Valve Replacement as an Alternative to Surgical Re-Replacement. J Am Coll Cardiol. 2020; 76(5):489-499. DOI: 10.1016/j.jacc.2020.06.010. View

18.

Leon M, Smith C, Mack M, Makkar R, Svensson L, Kodali S . Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016; 374(17):1609-20. DOI: 10.1056/NEJMoa1514616. View

19.

Adams D, Popma J, Reardon M, Yakubov S, Coselli J, Deeb G . Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014; 370(19):1790-8. DOI: 10.1056/NEJMoa1400590. View

20.

Smith D, Thorp M, Gurwitz J, McManus D, Goldberg R, Allen L . Chronic kidney disease and outcomes in heart failure with preserved versus reduced ejection fraction: the Cardiovascular Research Network PRESERVE Study. Circ Cardiovasc Qual Outcomes. 2013; 6(3):333-42. PMC: 3904800. DOI: 10.1161/CIRCOUTCOMES.113.000221. View