Procedural and long-term outcome among patients undergoing expedited trans-catheter aortic valve replacement
© 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC..
OBJECTIVE: Patients with rapidly deteriorating clinical status due to severe aortic stenosis are often referred for expedited transcatheter aortic valve replacement (TAVR). Data regarding the outcome of such interventions is limited. We aimed to evaluate the outcome of patients undergoing expedited TAVR.
DESIGN AND SETTING: Data were derived from the Israeli Multicenter Registry.
SUBJECTS: Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N = 3140) and those who had an expedited TAVR (N = 142). Procedural and periprocedural complication rates were significantly higher among patients with an expedited indication for TAVR compared to those having an elective procedure: valve malposition 4.6% versus 0.6% (p < 0.001), procedural cardiopulmonary resuscitation 4.3% versus 1.0% (p = 0.007), postprocedure myocardial infarction 2.0% versus 0.4% (p = 0.002), and stage 3 acute kidney injury 3.0% versus 1.1%, (p < 0.001). Patients with expedited indication for TAVR had significantly higher in hospital mortality (5.6% vs. 1.4%, p = 0.003). Kaplan-Meier's survival analysis showed that patients undergoing expedited TAVR had higher 3-year mortality rates compared to patients undergoing an elective TAVR procedure (p < 0.001). Multivariate analysis found that patients with expedited indication had fourfolds increased risk of in-hospital mortality (odds ratio: 4.07, p = 0.001), and nearly twofolds increased risk of mortality at 3-year (hazard ratio: 1.69, p = 0.001) compared to those having an elective procedure.
CONCLUSION: Patients with expedited indications for TAVR suffer from poor short- and long-term outcomes. It is important to characterize and identify these patients before the deterioration to perform TAVR in a fast-track pathway to minimize their procedural risk.
| Errataetall: |
CommentIn: Catheter Cardiovasc Interv. 2022 Nov;100(5):839-840. - PMID 36378719 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:100 |
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| Enthalten in: |
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions - 100(2022), 5 vom: 30. Nov., Seite 832-838 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Berkovitch, Anat [VerfasserIn] |
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| Links: |
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| Themen: |
Aortic valve |
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| Anmerkungen: |
Date Completed 18.11.2022 Date Revised 10.01.2023 published: Print-Electronic CommentIn: Catheter Cardiovasc Interv. 2022 Nov;100(5):839-840. - PMID 36378719 Citation Status MEDLINE |
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| doi: |
10.1002/ccd.30386 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Procedural and long-term outcome among patients undergoing expedited trans-catheter aortic valve replacement |
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| 500 | |a Date Revised 10.01.2023 | ||
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| 500 | |a CommentIn: Catheter Cardiovasc Interv. 2022 Nov;100(5):839-840. - PMID 36378719 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors. Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC. | ||
| 520 | |a OBJECTIVE: Patients with rapidly deteriorating clinical status due to severe aortic stenosis are often referred for expedited transcatheter aortic valve replacement (TAVR). Data regarding the outcome of such interventions is limited. We aimed to evaluate the outcome of patients undergoing expedited TAVR | ||
| 520 | |a DESIGN AND SETTING: Data were derived from the Israeli Multicenter Registry | ||
| 520 | |a SUBJECTS: Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N = 3140) and those who had an expedited TAVR (N = 142). Procedural and periprocedural complication rates were significantly higher among patients with an expedited indication for TAVR compared to those having an elective procedure: valve malposition 4.6% versus 0.6% (p < 0.001), procedural cardiopulmonary resuscitation 4.3% versus 1.0% (p = 0.007), postprocedure myocardial infarction 2.0% versus 0.4% (p = 0.002), and stage 3 acute kidney injury 3.0% versus 1.1%, (p < 0.001). Patients with expedited indication for TAVR had significantly higher in hospital mortality (5.6% vs. 1.4%, p = 0.003). Kaplan-Meier's survival analysis showed that patients undergoing expedited TAVR had higher 3-year mortality rates compared to patients undergoing an elective TAVR procedure (p < 0.001). Multivariate analysis found that patients with expedited indication had fourfolds increased risk of in-hospital mortality (odds ratio: 4.07, p = 0.001), and nearly twofolds increased risk of mortality at 3-year (hazard ratio: 1.69, p = 0.001) compared to those having an elective procedure | ||
| 520 | |a CONCLUSION: Patients with expedited indications for TAVR suffer from poor short- and long-term outcomes. It is important to characterize and identify these patients before the deterioration to perform TAVR in a fast-track pathway to minimize their procedural risk | ||
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