Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement

Abstract

Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality.

In-Hospital and One-Year Outcomes of Transcatheter Aortic Valve Replacement in Patients Requiring Supplemental Home Oxygen Use

“…Simialrly, in another STS/ACC TVT report from 2020 examing outcomes in 10,345 patients, home oxygen use was an independent predictor of 30-day unplanned hospital readmission [ 13 ]. Finally, in a 2021 report from Geisler et al examing outcomes from a single-center registry, home oxygen use was an independent predictor of procedural futility [ 14 ].…”

Fluoroscopy Time as a New Predictor of Short-Term Outcomes after Transcatheter Aortic Valve Replacement

“…Thus, we could assume that our results probably would have been even more consistent with a wider usage of USG, because of less fluoroscopy use during standard uncomplicated procedures. Moreover, bleeding and complication rates are different between transfemoral and other TAVR accesses [27]. Consequently, all those variables were balanced using PSM.…”

Long-Term Maintenance of Sinus Rhythm Is Associated with Favorable Echocardiographic Remodeling and Improved Clinical Outcomes after Transcatheter Aortic Valve Replacement

“…In previous literature, both pre-existing AF and NOAF were shown to be associated with increased post-TAVR mortality, complications and rehospitalization due to HF, but the relationship with stroke and bleeding remains unclear [ 5 , 8 , 9 , 12 , 22 , 23 ]. In the PARTNER trial, the presence of AF before or after TAVR was associated with increased mortality, but AF was not associated with an increased risk of stroke or major bleeding [ 8 ].…”