Outcomes of Non-Urgent Versus Urgent Transcatheter Aortic Valve Replacement
Tuesday, May 21, 2019
Belmont Ballroom 2-3 (The Cosmopolitan of Las Vegas)
Ayman Elbadawi
,
University of Texas Medical Branch at Galveston, Galveston, TX
Islam Y Elgendy, M.D.
,
University of Florida College of Medicine, Gainesville, FL
Amgad Mentias
,
Cleveland Clinic, Iowa city, IA
Marwan Saad, M.D., Ph.D.
,
Brown University Program, Warwick, RI
Mohamed Almahmoud, MD
,
UTMB, Galveston, TX
Gbolahan O Ogunbayo, M.D.
,
University of Kentucky, Lexington, KY
Hani Jneid, M.D., FSCAI
,
Baylor College of Medicine and Michael E. DeBakey Veterans Affair Medical Center, Houston, TX
Background:
Trans-catheter valve replacement (TAVR) is recommended for the management of patients with severe aortic stenosis (AS) who are at intermediate or higher risk for surgery. However, a paucity of data exists regarding outcomes of urgent TAVR.
Methods:
We queried the Nationwide Inpatient Sample (NIS) database years 2011-2014. Using propensity score matching, we compared patients who underwent TAVR in non-urgent versus urgent settings. Our main outcome was in-hospital mortality.
Results:
Our final analysis included 42,154 hospitalizations with TAVR; during which, 10,114 (24%) patients underwent urgent TAVR. There was an uptrend in the rate of urgent TAVR procedures (p=0.001), but no change in in-hospital mortality in this group over time (p=0.713). Predictors for undergoing urgent TAVR included: younger age, female gender, pulmonary circulation disorders, and chronic kidney disease. In the matched cohort, non-urgent TAVR was associated with lower mortality (OR=0.78; 95%CI: 0.69-0.89, p<0.001) compared with urgent TAVR. Also, non-urgent TAVR was associated with lower cardiogenic shock (OR=0.46; 95%CI: 0.40-0.53 p<0.001), use of MCS (OR=0.69; 95%CI: 0.59-0.82, p<0.001), AKI (OR=0.60; 95%CI: 0.56-0.64 p<0.001), hemodialysis for AKI (OR=0.67; 95%CI: 0.56-0.80 p<0.001), major bleeding (OR=0.94; 95%CI: 0.89-0.99 p=0.045). No significant difference was observed in acute stroke (OR=0.96; 95%CI: 0.81-1.14, p=0.636), vascular complications (OR=1.07; 95%CI: 0.89-1.29, p=0.492), and pacemaker insertions (OR=0.92; 95%CI: 0.84-1.01, p=0.067). Subgroup analysis within the urgent TAVR group showed higher mortality in patients ≤80 years (p=0.033), females (p<0.001), and those with history of chronic kidney disease (p=0.001), congestive heart failure (p<0.001), or liver disease (p=0.003).
Conclusions:
Data from the largest national database showed that almost a quarter of TAVR procedures were performed in urgent settings. Although urgent TAVR was associated with higher mortality and increased complications compared with non-urgent TAVR, the absolute difference in mortality is not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated.
