Author + information
- Received March 2, 2018
- Accepted March 2, 2018
- Published online June 18, 2018.
- Dhaval Kolte, MD, PhDa,
- Sahil Khera, MD, MPHb,
- Sreekanth Vemulapalli, MDc,
- Dadi Dai, PhDc,
- Stephan Heo, MDa,
- Andrew M. Goldsweig, MDd,
- Herbert D. Aronow, MD, MPHa,
- Sammy Elmariah, MD, MPHb,
- Ignacio Inglessis, MDb,
- Igor F. Palacios, MDb,
- Vinod H. Thourani, MDe,
- Barry L. Sharaf, MDa,
- Paul C. Gordon, MDa and
- J. Dawn Abbott, MDa,∗ ()
- aDivision of Cardiology, Brown University, Providence, Rhode Island
- bDivision of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
- cDivision of Cardiology, Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
- dDivision of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska
- eDepartment of Cardiac Surgery, MedStar Washington Hospital Center, Washington, DC
- ↵∗Address for correspondence:
Dr. J. Dawn Abbott, Department of Medicine, Division of Cardiology, Warren Alpert Medical School of Brown University, 593 Eddy Street, RIH APC814, Providence, Rhode Island 02903.
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.
- aortic stenosis
- cardiogenic shock
- heart failure
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
This research was supported by the Society of Thoracic Surgeons/American College of Cardiology’s TVT Registry. Dr. Vemulapalli has received grants from the American College of Cardiology, Society of Thoracic Surgeons, Patient Centered Outcomes Research Institute, Abbott Vascular, and Boston Scientific; and has consulted for Novella and Boston Scientific. Dr. Elmariah has been a consultant for Edwards Lifesciences and Medtronic; and has received research grants from Boehringer Ingelheim and Siemens. Dr. Thourani has served as an advisor for Edwards Lifesciences, Boston Scientific, and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. The STS/ACC TVT Registry is an initiative of The Society of Thoracic Surgeons and the American College of Cardiology. The views expressed in this paper represent those of the author(s), and do not necessarily represent the official views of the National Cardiovascular Data Registries (NCDR) or its associated professional societies. This study will be presented as a moderated poster at the 2018 American College of Cardiology 67th Scientific Session & Expo in March in Orlando, FL.
- Received March 2, 2018.
- Accepted March 2, 2018.
- 2018 American College of Cardiology Foundation
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