Mortality Predictors in Patients Referred for but Not Undergoing Transcatheter Aortic Valve Replacement

Kang, Donna; Bach, David S.; Chetcuti, Stanley; Deeb, G. Michael; Grossman, Paul; Patel, Himanshu J.; Menees, Daniel S.; Romano, Matthew A.; LaBounty, Troy

doi:10.1016/j.amjcard.2015.06.014

Cited by 11 publications

(3 citation statements)

References 12 publications

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“…An especially poor prognosis was observed when the cited reason for not proceeding with TAVR was comorbidities. Specific comorbidities found to be prevalent and influential for decision making were reduced LVEF, severe chronic kidney disease, and dementia; consistent with prior studies [10]. In a report from the STS/ACC TVT Registry, dialysis-dependent kidney disease was associated with a twofold increase in 1-year mortality rate up to 37% [11].…”

Section: Discussionsupporting

confidence: 84%

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement

Rodighiero

Piazza

Martucci

et al. 2020

BMC Cardiovasc Disord

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Background: Few studies have measured frailty as a potential reason for foregoing transcatheter aortic valve replacement (TAVR) in older adults with severe aortic stenosis (AS). This study sought to determine the impact of frailty and other clinician-cited reasons on restricted mean survival time (RMST). Methods: An analysis of the McGill Frailty Registry was conducted between 2014 and 2018 at the McGill University Health Center Structural Valve Clinic. Consecutive nonsurgical patients referred for TAVR were included. In those that underwent balloon aortic valvuloplasty or medical management, the primary clinician-cited reason for foregoing TAVR was codified. Vital status was ascertained at 1 year and analysed using RMST and Kaplan-Meier analyses. Results: The study consisted of 373 patients with a mean age of 82.4 years, of which 233 underwent TAVR and 140 did not. Patients who did not undergo TAVR were more likely to be nonagenarians, with left ventricular dysfunction, chronic kidney disease, dementia, disability, depression, malnutrition, and frailty. The primary cliniciancited reason was: comorbidity in 34%, frailty in 23%, procedural feasibility and risks in 16%, and mild or unrelated symptoms in 27%. Compared to the TAVR group, 1-year RMST was reduced by 2.0 months in the medical management group (95% CI 1.2, 2.7) and by 1.1 months in the valvuloplasty group (95% CI-0.2, 2.5). Conclusions: Patients with severe AS referred for TAVR may never undergo the procedure on the basis of comorbidity, frailty, procedural issues, and symptoms. The best treatment decision is one that follows from multidisciplinary assessment encompassing frailty.

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Section: Discussionsupporting

confidence: 84%

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement

Rodighiero

Piazza

Martucci

et al. 2020

BMC Cardiovasc Disord

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“…Interestingly, the reduction in all-cause mortality is not associated with statin therapy in patients with aortic stenosis who did not undergo TAVI. 43 This finding may suggest an additional benefit of statin therapy after TAVI. However, to this date, there is no evidence that TAVI alone, could be an indication to start statins and more high-quality randomized clinical trials are needed to assess the potential beneficial effects of statins in reducing mortality after TAVI in patients without any other statin therapy indications.…”

Section: Discussionmentioning

confidence: 87%

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

et al. 2022

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While TAVI is widely used, optimal medical therapy to reduce the mortality rate after transcatheter aortic valve implantation (TAVI) is still unclear. We performed a systematic review and meta-analysis to evaluate the impact of statins on mortality following TAVI. Present systematic review of the literature was performed using Medline, Embase, Scopus, and Web of Science; all studies reported all-cause mortality in patients who underwent TAVI and received or did not receive statin therapy. Data were analyzed using random-effects models. Seventeen articles (21 380 patients) were included in the meta-analysis. Statin therapy was associated with a reduction of all-cause mortality (Hazard ratio [HR] = .78, 95% Confidence interval [CI] .68–.89, P < .001). Moderate between-study heterogeneity was observed (I2 = 45.2). High-intensity statin therapy was more effective than low or moderate intensity statin therapy in reduction of all-cause mortality (Risk ratio [RR] = .62, 95% CI 0.45–.85, P = .003, I2 = .0). Statin therapy could reduce the mid-term all-cause mortality rate following TAVI. However, all included studies were observational and, therefore, randomized controlled trials are still needed to assess the effect of statin therapy on mortality after TAVI.

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“…Previous studies have reported that frailty scores, which are known to be associated with 1-year mortality 22 , worsened in elderly patients while waiting for TAVR 11 . Additionally, myocardial overload may get worse leading to heart failure and reduced ventricular function which represents a prognostic turning point in AS 23 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement

Roule

Rebouh

Lemaître

et al. 2022

Sci Rep

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Wait times are associated with mortality on waiting list for transcatheter aortic valve replacement (TAVR). Whether longer wait times are associated with long term mortality after successful TAVR remains unassessed. Consecutive patients successfully treated with elective TAVR in our center between January 2013 and August 2019 were included. The primary end point was one-year all-cause mortality. TAVR wait times were defined as the interval from referral date for valve replacement to the date of TAVR procedure. A total of 383 patients were included with a mean wait time of 144.2 ± 83.87 days. Death occurred in 55 patients (14.4%) at one year. Increased wait times were independently associated with a relative increase of 1-year mortality by 2% per week after referral (Adjusted Hazard Ratio 1.02 [1.002–1.04]; p = 0.02) for TAVR. Chronic kidney disease, left ventricular ejection fraction ≤ 30%, access site and STS score were other independent correlates of 1-year mortality. Our study shows that wait times are relatively long in routine practice and associated with increased 1-year mortality after successful TAVR. Such findings underscore the need of strategies to minimize delays in access to TAVR.

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Mortality Predictors in Patients Referred for but Not Undergoing Transcatheter Aortic Valve Replacement

Cited by 11 publications

References 12 publications

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement

Restricted mean survival time of older adults with severe aortic stenosis referred for transcatheter aortic valve replacement

Statins and Mortality of Patients After Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis

Impact of wait times on late postprocedural mortality after successful transcatheter aortic valve replacement

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