Outcomes of Urgent Transcatheter Aortic Valve Replacement in Patients With Acute Decompensated Heart Failure: A Single-Center Experience.

Jesus E Pino,Kayla Polcari,Kai Chen,Waqa Ghumman,Marcos Nores,Robert Chait,Sotiris Stamou,Mark Rothenberg,Taylor Michiko,Cristiano Faber

doi:10.7759/cureus.10425

Abstract

BackgroundData on urgent transcatheter aortic valve replacement (TAVR) as rescue therapy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) are limited. We sought to investigate the outcomes of patients who underwent urgent transcatheter aortic valve replacement (TAVR) in a single institution.MethodsThis is a retrospective cohort study of 602 patients with a history of heart failure (HF) due to AS who underwent TAVR between April 2012 and July 2017. We stratified patient cohort into urgent (n=139) and elective (n=463) TAVR. Urgent TAVR was defined as patients who were admitted for ADHF and underwent TAVR during the same hospitalization. Patients that underwent urgent TAVR for other reasons were excluded.ResultsRates of postoperative intra-aortic balloon pump requirement, atrial fibrillation, dialysis requirement, vascular complications, and stroke were similar between the two groups. Compared with elective TAVR, patients undergoing urgent TAVR had a higher rate of cardiac arrest (5.7% vs 1.3%, p=0.005), longer length of stay (LOS) (11 vs. 5, p<0.001), and significant 30-day mortality (8.6% vs 4.1%, HR 2.1, 95% CI 1.04-4.22). Patients who underwent urgent TAVR were also associated with long-term mortality (Log-rank p = 0.0162).ConclusionsIn our study, urgent TAVR for ADHF was associated with both short-term and long-term mortality as compared to elective TAVR. Further randomized studies are needed to investigate the appropriate management of this population.

Highlights

Aortic stenosis (AS) is the most common valvular heart disease in the Western world, and nearly 3.4% of the elderly population has severe aortic stenosis (AS) [1]
Rates of postoperative intra-aortic balloon pump requirement, atrial fibrillation, dialysis requirement, vascular complications, and stroke were similar between the two groups
Compared with elective transcatheter aortic valve replacement (TAVR), patients undergoing urgent TAVR had a higher rate of cardiac arrest (5.7% vs 1.3%, p=0.005), longer length of stay (LOS) (11 vs. 5, p

Summary

Introduction

Aortic stenosis (AS) is the most common valvular heart disease in the Western world, and nearly 3.4% of the elderly population has severe AS [1]. Patients with a history of SAS and heart failure may experience acute decompensation, which requires urgent intervention. Balloon aortic valvuloplasty (BAV) was considered emergent “bridging” therapy for these patients, it has been shown to be associated with frequent complications such as only short-term efficacy and the risk of postoperative severe aortic regurgitation [3]. Transcatheter aortic valve replacement (TAVR) had emerged as an effective therapy for patients at prohibitive to low surgical risks [46]. Recent studies have found that urgent or emergent TAVR might be feasible and effective in patients with severe AS and acute decompensation [7,8,9]. Data on urgent transcatheter aortic valve replacement (TAVR) as rescue therapy for acute decompensated heart failure (ADHF) due to severe aortic stenosis (AS) are limited. We sought to investigate the outcomes of patients who underwent urgent transcatheter aortic valve replacement (TAVR) in a single institution

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