Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement: Insights From the STS/Acc TVT Registry

Kolte, Dhaval; Khera, Sahil; Vemulapalli, Sreekanth; Dai, Dadi; Heo, Stephan; Goldsweig, Andrew M.; Aronow, Herbert D.; Inglessis, Ignacio; Elmariah, Sammy; Sharaf, Barry; Gordon, Paul; Abbott, J.

doi:10.1016/s0735-1097(18)31550-x

Cited by 28 publications

(60 citation statements)

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“…Our mortality data is consistent with those reported from the TVT registry . However, mortality rates overall were higher in the TVT registry; a finding that is probably attributable to a population with more comorbidities, higher use of GA and transapical access and experience that encompasses earlier versions of TAVI technology.…”

Section: Discussionsupporting

confidence: 88%

“…However, for many patients, the outcome from this strategy is poor. Medical therapy alone is known to have limited value in symptomatic AS and even after BAV, AS may not be relieved and only marginally reduces the risk of recurrent ADAS . Furthermore, reported 30‐day mortality rates are higher following BAV, ranging between 11.6 and 47%, than those we now report for TAVI in a similar cohort .…”

Section: Discussionmentioning

confidence: 47%

“…Current guidelines indicate intervention in the majority of cases only when patients develop symptoms with good outcomes reported for elective SAVR and TAVI . However, a significant proportion of patients (7.3–21%) continue to present acutely with a combination of pulmonary edema, heart failure, angina, syncope, or sudden death . The ideal management of this patient cohort with acute decompensated aortic stenosis (ADAS) is unclear.…”

Section: Introductionmentioning

confidence: 99%

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Transcatheter aortic valve implantation in acute decompensated aortic stenosis

Patel

Broyd²,

Chehab³

et al. 2019

Cathet Cardio Intervent

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Objectives To assess the safety and efficacy of first‐line transcatheter aortic valve implantation (TAVI) in patients presenting with acute decompensated aortic stenosis (ADAS). Background ADAS is common and is often treated medically or using balloon aortic valvuloplasty in the first instance. This temporizing measure results in suboptimal outcomes. In the current era, TAVI provides an alternative option. Methods Consecutive patients who had either a TAVI for ADAS or electively were included in the study. The primary outcome was procedural and 30‐day mortality and hospital length of stay (LOS). Secondary outcomes included 1‐year mortality and procedural complications. Results Of note, 893 patients (mean age 83 ± 7, 50.5% male) underwent TAVI (19% ADAS, 81% elective). ADAS patients were more unwell with worse echocardiographic parameters than elective patients. ADAS patients of 55.9% were known to have significant aortic stenosis prior to their decompensation. Procedural mortality was not different between the ADAS and elective cohorts (1.2 vs. 0.7%; p = .62). The ADAS cohort had a higher 30‐day mortality (5.3 vs. 1.1%; p = .002) and longer LOS (31.9 ± 20.7 days vs. 6.1 ± 6.5 days; p < .001). Multivariate analysis identified acute kidney injury and ADAS as significant predictors of 30‐day mortality. Conclusions TAVI for ADAS is safe and effective with procedural outcomes similar to elective patients. However, compared to elective patients, they have worse physiological baseline features, poorer prognosis at 30 days, and longer hospital admissions. Majority of patients who presented with ADAS were known to have AS prior to admission.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 99%

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Transcatheter aortic valve implantation in acute decompensated aortic stenosis

Patel

Broyd²,

Chehab³

et al. 2019

Cathet Cardio Intervent

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“…17 In view of the similar risk of adverse events after balloon aortic valvuloplasty and TAVR, 18 patients with AHF secondary to severe AS may be considered for primary TAVR. Although this may require changes of the diagnostic and treatment pathway, 19 However, the present study was not able to document the validity of TAVR over SAVR in this setting because of the limited number of patients included in this analysis. In propensity score matched pairs of patients, SAVR was associated with increased risk of major bleeding, acute kidney injury, and prolonged hospital stay compared with TAVR and, after a mean follow-up of 2.9 years, 3-year survival was similar in the study cohorts.…”

Section: Commentmentioning

confidence: 83%

Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure

Jalava

Laakso

Virtanen

et al. 2020

The Annals of Thoracic Surgery

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“…To the best of our knowledge, the current study is the largest European multicenter series reporting on safety and feasibility of TAVI in patients in CS (Table S2). Previous study like the STS/ACC TVT Registry sub‐analysis reported on urgent and/or emergent TAVI, but the inclusion criteria were less restrictive including also ACS without hemodynamic instability 23 …”

Section: Discussionmentioning

confidence: 99%

Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI‐shock registry results

Fraccaro

Teles

Tchétché

et al. 2020

Cathet Cardio Intervent

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Objectives Aim of this study is to evaluate safety, feasibility, and mid‐term outcome of transcatheter aortic valve implantation (TAVI) in cardiogenic shock (CS). Background Balloon aortic valvuloplasty in patients with severe aortic valve stenosis (SAS) complicated by CS is indicated but associated with a grim prognosis. TAVI might be a more reasonable treatment option in this setting but data are scant. Methods From March 2008 to February 2019, 51 patients with severe aortic valvulopathy (native SAS or degenerated aortic bioprosthesis) and CS treated by TAVI in 11 European centers were included in this multicenter registry. Demographic, clinical, and procedural data were collected, as well as clinical and echocardiographic follow‐up. Results The mean age of our study population was 75.8 ± 13, 49% were women, and mean Society of Thoracic Surgeons (STS) score was 19 ± 15%. Device success was achieved in 94.1%, with a 5% incidence of moderate/severe paravalvular leak. The 30‐day events were mortality 11.8%, stroke 2.0%, vascular complications 5.9%, and acute kidney injury 34%. Valve Academic Research Consortium‐2 early safety endpoint was reached in 35.3% of cases. At 1‐year of follow‐up, the mortality rate was 25.7% and the readmission for congestive heart failure was 8.6%. Conclusions TAVI seems to be a therapeutic option for patients with CS and SAS or degenerated aortic bioprosthesis in terms of both safety and efficacy at early and long‐term follow‐up.

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Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement: Insights From the STS/Acc TVT Registry

Cited by 28 publications

References 0 publications

Transcatheter aortic valve implantation in acute decompensated aortic stenosis

Transcatheter aortic valve implantation in acute decompensated aortic stenosis

Transcatheter and Surgical Aortic Valve Replacement in Patients With Recent Acute Heart Failure

Transcatheter aortic valve implantation (TAVI) in cardiogenic shock: TAVI‐shock registry results

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