Urgent versus Non-Urgent Transcatheter Aortic Valve Implantation Outcomes

Abstract

<b><i>Introduction:</i></b> There are limited data about the outcomes of nonelective transcatheter aortic valve implantation (TAVI). Some studies suggest that these patients (pts) have worst results. Our purpose was to compare outcomes in pts submitted to urgent versus elective TAVI. <b><i>Methods:</i></b> Retrospective analysis of 298 consecutive pts submitted to TAVI between 2018 and 2021 in a single tertiary center. Baseline characteristics and outcomes were collected and compared between elective and nonelective TAVI. <b><i>Results:</i></b> Pts submitted to urgent TAVI (79 pts) had worse baseline characteristics, with higher EuroScore risk (9.26 vs. 5.17%, <i>p</i> < 0.0001), STS score (7.09 vs. 4.4%, <i>p</i> < 0.0001), and NT pro-natriuretic peptide B (10,168 vs. 3,241 pg/mL, <i>p</i> = 0.001), lower left ventricle ejection fraction (45 vs. 52%, <i>p</i> = 0.003), more diabetes (46.8 vs. 32.4%, <i>p</i> = 0.0.22), peripheral artery disease (21.5 vs. 6.8%, <i>p</i> < 0.0001), and poor vascular accesses (18.4 vs. 7.4%, <i>p</i> = 0.007). Urgent TAVI was associated with higher mortality (25.3 vs. 15.1%, <i>p</i> = 0.043), 30-day cardiovascular mortality (17.5 vs. 4%, <i>p</i> = 0.001), life-threatening bleeding (11.5 vs. 4.1%, <i>p</i> = 0.018), vascular complications (11.5 vs. 4.6%, <i>p</i> = 0.031), and longer hospital stay (28 vs. 12 days, <i>p</i> < 0.0001), but not with intensive care unit or post-TAVI hospital stay (5 vs. 4 days, <i>p</i> = 0.197 and 11 vs. 10 days, <i>p</i> = 0.572). When adjusted to differences in baseline characteristics, urgent TAVI was only associated with longer hospital stay (<i>p</i> < 0.0001). <b><i>Conclusion:</i></b> Pts submitted to urgent TAVI have worse short-term outcomes, but this seems to be attributable to the worse baseline characteristics instead of the urgent nature of the procedure.

Transcatheter Structural Heart Interventions in the Acute Setting: An Emerging Indication

“…Similarly, Castello et al [ 32 ] showed that in the unadjusted population, urgent TAVI was associated with an increased mortality rate (25.3 vs. 15.1%, p = 0.043), 30-day cardiovascular mortality (17.5 vs. 4%, p = 0.001), major bleeding (11.5 vs. 4.1%, p = 0.018), and vascular complications (11.5 vs. 4.6%, p = 0.031), as well as increased hospital stay, compared to elective TAVI. However, after adjustment for baseline characteristics, the only outcome that remained significantly different was the length of hospital stay.…”