Urgent transcatheter aortic valve implantation in an all-comer population: a single-centre experience

Arpad Lux,Suzanne Kats,Leo F. Veenstra,Jos G. Maessen,Bart Maesen,Wim Dohmen,Arnoud W. J. van ’t Hof

doi:10.1186/s12872-021-02347-1

Abstract

BackgroundWhen compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-TAVI) seems to improve mortality rates. We performed a single centre, retrospective cohort analysis to characterize our u-TAVI population and to identify potential predictors of worse outcomes.MethodsWe performed a retrospective analysis of 631 consecutive TAVI patients between 2013 and 2018. Of these patients, 53 were categorized as u-TAVI. Data was collected from the local electronic database.ResultsUrgent patients had more often a severely decreased left ventricular ejection fraction (LVEF < 30%) and increased creatinine levels (115.5 [88–147] vs 94.5 [78–116] mmol/l; p = 0.001). Urgent patients were hospitalised for 18 [10–28] days before and discharged 6 [4–9] days after the implantation. The incidence of peri-procedural complications and apical implantations was comparable among the study groups. Urgent patients had higher in-hospital (11.3% vs 3.1%; p = 0.011) and 1-year mortality rates (28.2% vs 8.5%, p < 0.001). An increased risk of one-year mortality was associated with urgency (HR 3.5; p < 0.001), apical access (HR 1.9; p = 0.016) and cerebrovascular complications (HR 4.3; p = 0.002). Within the urgent group, the length of pre-hospital admission was the only significant predictor of 1-year mortality (HR 1.037/day; p = 0.003).ConclusionsCompared to elective procedures, u-TAVI led to increased mortality and comparable complication rates. This detrimental effect is most likely related to the length of pre-procedural hospitalisation of urgent patients.

Highlights

When compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-Transcatheter Aortic Valve Implantation (TAVI)) seems to improve mortality rates
Recent studies have proven that Transcatheter Aortic Valve Implantation (TAVI) is a viable treatment option for symptomatic aortic valve stenosis (AoS), regardless of surgical risk [1,2,3,4]
The diagnosis of aortic stenosis was made by the referring physician and was validated by the local Heart-Team and TAVI experts

Summary

Introduction

When compared with older reports of untreated symptomatic aortic valve stenosis (AoS), urgent transcatheter aortic valve implantation (u-TAVI) seems to improve mortality rates. Recent studies have proven that Transcatheter Aortic Valve Implantation (TAVI) is a viable treatment option for symptomatic aortic valve stenosis (AoS), regardless of surgical risk [1,2,3,4]. These results will without doubt broaden the range of TAVI indications and subsequently lead to an increase in the number of TAVI procedures. European and American guidelines suggest balloon aortic valvuloplasty as an emergent solution, a bridge to definitive treatment They do not give advice on urgent clinical scenarios when patients are not in a critical condition but are not advised to leave the hospital without aortic valve replacement [5,6,7].

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