Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention

Saldivar, Hugo González; Alaminos, Lourdes Vicent; Rodríguez-Pascual, Carlos; Morena, Gonzalo de la; Fernández-Golfín, Covadonga; Amoros, Cirilo; Alonso, M. Baquero; Dolz, Luis Martínez; Solé, Albert Ariza; Guzmán‐Martínez, Gabriela; Gómez‐Doblas, Juan José; Jiménez, Antonio Arribas; Fuentes, María Eugenia; Ortiz, Martín Ruiz; Avanzas, Pablo; Abu‐Assi, Emad; Ripoll‐Vera, Tomás; Dı́az-Castro, Óscar; Osinalde, Eduardo Pozo; Bernal, Eva; Martínez‐Sellés, Manuel

doi:10.1016/j.rec.2018.03.023

Cited by 6 publications

(7 citation statements)

References 30 publications

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“…The mean wait time in our study (144 days) appears important. This remains poorly described in the literature with a mean time varying between 89 and 132 days 9 , 10 , 13 , 18 . Such delay in our cohort may be explained by the fact that our center is a tertiary reference center for a mostly rural region.…”

Section: Discussionmentioning

confidence: 98%

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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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Section: Discussionmentioning

confidence: 98%

“…Previous studies have reported that 2–14% of patients referred for TAVR die while on the waiting list 10 , 18 , 19 . Recently, a study focused on the impact of wait times on early post-TAVR outcomes and found a somewhat unexpected higher hazard associated with short wait times 13 .…”

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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“…In our study patients with ADHF on the waiting list for TAVI represented 61% of the deaths within 100 days after being addressed to our institution. When these patients are taken into account, the overall mortality increased by 20% at 1‐year follow‐up, underlining the need to identify the patients at high risk and to schedule early intervention 6 . A broad literature is available on the importance of waiting‐time management in health care, especially after coronary angiography and the waiting period for cardiac surgery 23,24 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, TAVI is becoming a front‐line therapy in patients with both severe AS and HF since the majority of such patients possess a too high surgical risk 2,4,5 . Despite a favorable procedural outcome and hemodynamic results after TAVI, a substantial proportion of these patients dies within the first months 6,7 . Moreover, many patients with severe AS and HF are treated conservatively.…”

Section: Introductionmentioning

confidence: 99%

Prognostic influence of acute decompensated heart failure in patients planned for transcatheter aortic valve implantation

Popovic

Molho

Varlot

et al. 2020

Cathet Cardio Intervent

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Objective The aim of our study was to evaluate the outcome of patients with severe aortic stenosis presenting with acute decompensated heart failure (ADHF) and planned for transcatheter aortic valve implantation (TAVI) and to study the variables influencing their prognosis. Methods Our retrospective study included 801 patients planned for TAVI in our center. Seven hundred and fifty‐six underwent TAVI and were categorized according to ADHF as the initial clinical presentation into two groups: ADHF group (n = 261) and no‐ADHF group (n = 495). Pre as well as periprocedural outcomes and 1 year mortality were analyzed. Results Among the patients planned for the TAVI procedure, 45 patients remained untreated: 35 patients died while waiting to undergo TAVI which represented 20% of all deaths in our study, ADHF was observed in 23 of 45 (51%) these untreated patients. The 1‐year all‐cause mortality rate was significantly higher in the ADHF group versus the no‐ADHF group (27% vs. 15%, p < .0001). In multivariate analysis, male gender (odds ratio [OR] =2.5, 95% confidence interval [CI]: 1.37–4.57, p = .03), body mass index <25 kg/m2 (OR = 2.76, 95% CI: 1.51–5.04, p = .0009), and logistic EuroSCORE II ≥20% (OR = 3.04, 95% CI: 1.56–5.94, p = .001) were associated with a higher 1‐year mortality in the ADHF group. Conclusion The patients eligible for TAVI presenting with ADHF were associated with a higher mortality for both: while on the waiting list for TAVI as well as at 1‐year follow‐up and thus asking for clearer criteria to prioritize action in this high‐risk TAVI patients.

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“…However, other clinical variables also influence this decision, and even patients with high BNP may not benefit from an intervention if they have cognitive dysfunction, frailty or other relevant comorbidities4 (figure 1). Further, some variables such as significant mitral regurgitation might be related to a poor prognosis,5 but their presence could favour a decision for conservative treatment 6. TAVI has not been previously studied in patients with asymptomatic severe AS; however, low procedural complication rates, short hospital length of stay, zero mortality and zero disabling stroke at 30 days were reported in a recent study of low-risk patients with symptoms, which may be the most similar scenario 7…”

mentioning

confidence: 99%

Asymptomatic severe aortic stenosis: biomarkers are welcome

Martínez‐Sellés

Bayés‐Genís

2018

Heart

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Prognosis of Patients With Severe Aortic Stenosis After the Decision to Perform an Intervention

Cited by 6 publications

References 30 publications

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

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

Prognostic influence of acute decompensated heart failure in patients planned for transcatheter aortic valve implantation

Asymptomatic severe aortic stenosis: biomarkers are welcome

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