Elective versus urgent in‐hospital transcatheter aortic valve implantation

Abstract

Background Transcatheter aortic valve implantation (TAVI) is maturing as a treatment option and is now often undertaken during an unscheduled index hospital admission. The aim of this study was to look at procedural and mid‐term outcomes of patients undergoing elective versus urgent in‐hospital transcatheter aortic valve implantation. Methods We identified a total of 1,157 patients who underwent TAVI between November 2007 and November 2019 at the Sussex Cardiac Centre in the UK. We compared the demographics, procedural outcomes, 30‐day and 1‐year mortality between elective and urgent patients. Emergency and salvage TAVI cases were excluded. Results Of the 1,157 patients who underwent the procedure, 975 (84.3%) had elective while 182 (15.7%) had urgent TAVI. Predominant aortic stenosis was more frequent in elective patients (91.7% vs. 77.4%); p < .01), while predominant aortic regurgitation was seen more commonly in the urgent group (11.5% vs. 4.2%; p < .01). Implantation success was similar between the elective (99.1%) and urgent group (99.4%). In‐hospital (1.65% vs. 1.3%: p .11), 30 day (3.5% vs. 3.3%: p .81) and 1 year (10.9% vs. 11%; p .81) mortality rates were similar in the elective and urgent groups, respectively. Conclusions In contemporary practice, urgent TAVI undertaken on the index admission can be performed at similar risk to elective outpatient TAVI.

Efficacy and Safety of Emergent Transcatheter Aortic Valve Implantation in Patients with Acute Decompensated Aortic Stenosis: Systematic Review and Meta-Analysis

“…With regard to mortality during hospitalization and one year after TAVI, there were 7 [ 8 , 10 , 13 – 17 ] and 9 [ 4 , 8 , 10 , 11 , 13 , 17 ] studies describing the pertinent data, respectively. A significant difference was noted between emergent and elective TAVI on the mortality at hospitalization (emergent vs selective, HR 2.09, 95% CI [1.39 to 3.14], I 2 = 86.5%, Q test P < 0.001, Figure 4(a) ) and 1 year (HR 1.96, 95% CI [1.55 to 2.49], I 2 = 66.2%, Q test P =0.003, Figure 4(b) ) in the random effect model.…”

Urgent versus Non-Urgent Transcatheter Aortic Valve Implantation Outcomes

“…Previous studies showed that in patients with AS, hospitalization for acute decompensation is associated with poor outcomes [2,3,5], and some data point to a better prognosis in this cohort of patients if treated with SAVR (33% 5-year mortality, 23.2% HF hospitalization) compared to conservative management (75.3% 5-year mortality, 70.4% HF hospitalization), although the results are still worse than in elective procedures (17.3% 5-year mortality, 4.8% HF hospitalization) [5]. Robust data concerning TAVI outcomes in this specific population are limited, and there are discrepancies in the published studies, with most of them showing worse outcomes (mortality, acute kidney injury, bleeding, rehospitalization) [5,[11][12][13] in urgent procedures, but with few data suggesting similar results concerning mortality, hospitalization and other adverse events [14,15].…”

“…Since the first percutaneous aortic valve was implanted in 2002, a significant evolution in TAVI technology has occurred, allowing the treatment of more patients, from low-to very-high risk [6][7][8][9][10]. Despite that, there is still some uncertainty regarding TAVI results in patients submitted to urgent procedures, with most literature suggesting that this subgroup of patients tend to have worse results, but some data pointing to similar outcomes [5,[11][12][13][14][15]. There is also a gap in the guidelines concerning aortic valve replacement in this acute setting, with only a brief recommendation for aortic balloon valvuloplasty as a bridge to TAVI or surgical aortic valve replacement (SAVR) in decompensated AS [16].…”

Clinical Outcomes of Urgent or Emergency Transcatheter Aortic Valve Implantation ― Insights From the Nationwide Registry of Japan Transcatheter Valve Therapies ―

“…This rate of urgent/emergency TAVI was lower than that of 10-24% reported in Western countries. 6,[11][12][13] In many countries, TAVI can be performed in the cardiac catheterization laboratory, as well as in the hybrid operation room, according to guidelines or consensus documents. 14 Furthermore, the feasibility and safety of TAVI performed in the cardiac catheterization laboratory have been widely reported.…”