Mortality at one year after transcatheter aortic valve replacement - Relation of age and comorbidities.

Abstract

Of patients undergoing transcatheter aortic valve replacement (TAVR), 80-90% are at extreme, high, or intermediate risk. Patient selection considering futile outcomes in these groups is difficult as significant comorbidity burden is common. Thus, we examined 1-year mortality after TAVR according to age and comorbidities. Between 2008 and 2021 all Danish TAVR-patients were included. From a multivariate Cox-regression model, significant characteristics associated with 1-year all-cause mortality were identified. The study population was divided into four groups according to number of significant comorbidities present at baseline: Low (0 comorbidities), mild (1 comorbidity), moderate (2 comorbidities), and high (3 or more comorbidities). The 1-year risk of all-cause mortality with 95% confidence intervals (CI) was estimated by each group. In total, 7,104 patients underwent TAVR. Significant covariates associated with 1-year all-cause mortality were chronic kidney disease, heart failure, chronic obstructive pulmonary disease, peripheral artery disease, and age≥85years. The four baseline groups comprised low (n=2,666), mild (n=2,814), moderate (n=1,246), and high comorbidity burden (n=378). The 1-year risk of all-cause mortality was 5.5% (95%CI: 4.6-6.4%) in the low baseline comorbidity burden group. Conversely, the 1-year risk of all-cause mortality was 25.0% (95%CI: 20.4-29.3%) in the high baseline burden group. In a national sample of TAVR patients, readily available information on age and comorbidities, can be used to identify a high-risk group with 25% 1-year mortality. This provides physicians and patients with an easy-to-understand view on 1-year prognosis after TAVR and may complement patient selection for improved long-term outcomes.