Author + information
- Received March 2, 2018
- Accepted March 2, 2018
- Published online March 11, 2018.
- Dhaval Kolte, MD, PhD1,
- Sahil Khera, MD, MPH2,
- Sreekanth Vemulapalli, MD3,
- Dadi Dai, PhD3,
- Stephan Heo, MD1,
- Andrew Goldsweig, MD4,
- Herbert D. Aronow, MD, MPH1,
- Sammy Elmariah, MD, MPH2,
- Ignacio Inglessis, MD2,
- Igor F. Palacios, MD2,
- Vinod H. Thourani, MD5,
- Barry L. Sharaf, MD1,
- Paul C. Gordon, MD1 and
- J. Dawn Abbott, MD1,∗ ()
- 1Brown University, Providence, RI
- 2Massachusetts General Hospital, Boston, MA
- 3Duke Clinical Research Institute, Duke University Medical Center, Durham, NC
- 4University of Nebraska Medical Center, Omaha, NE
- 5MedStar Washington Hospital Center, Washington, DC
- ↵∗Address for correspondence: J. Dawn Abbott, MD Department of Medicine, Division of Cardiology Warren Alpert Medical School of Brown University 593 Eddy Street RIH APC814 Providence, RI 02903 Phone: (401) 444-8540; Fax: (401) 444-8158.
Background Data on urgent/emergent transcatheter aortic valve replacement (TAVR) as a rescue therapy for decompensated severe aortic stenosis (AS) are limited.
Objectives To examine outcomes and identify independent predictors of mortality among patients undergoing urgent/emergent TAVR.
Methods The STS/ACC TVT Registry linked with Centers for Medicare and Medicaid Services claims was used to identify patients who underwent urgent/emergent vs. 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 [7.6, 17.9]). Device success rate was statistically lower, but not clinically different after urgent/emergent vs. elective TAVR (92.6% vs. 93.7%, P=0.007). Rates of major/life-threatening bleeding, major vascular complications, myocardial infarction, stroke, new permanent pacemaker placement, conversion to SAVR, and paravalvular regurgitation were similar between the two groups. Compared with elective TAVR, patients undergoing urgent/emergent TAVR had higher rates of acute kidney injury/new dialysis (8.2% vs 4.2%, P<0.001), 30-day mortality (8.7% vs 4.3%, adjusted HR 1.28, 95% CI 1.10-1.48), and 1-year mortality (29.1% vs 17.5%, adjusted HR 1.20, 95% CI 1.10-1.31). 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
- transcatheter aortic valve replacement
- transcatheter aortic valve implantation
- heart failure
- cardiogenic shock
This research was supported by the Society of Thoracic Surgeons/American College of Cardiology’s TVT Registry.
STS/ACC TVT Registry is an initiative of The Society of Thoracic Surgeons and the American College of Cardiology. The views expressed in this manuscript 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 identified at CVQuality.ACC.org/NCDR.
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; has consulted for Novella and Boston Scientific.
Dr. Thourani serves as an advisor for Edwards Lifesciences, Boston Scientific, and Abbott Vascular.
All other authors have no conflicts of interest to disclose.
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.