Author + information
- 1West Virginia University Heart and Vascular Institute, morgantown, West Virginia, United States
- 2West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, United States
- 3West Virginia University Heart and Vascular Institute, Morgantwon, West Virginia, United States
- 4Mayo Clinic, Rochester, Minnesota, United States
Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis (AS) who are symptomatic or have reduced ventricular function. However, although AS is a chronic evolving condition, many patients are referred for valve replacement on a non-elective basis. Data on the incidence and outcomes of non-elective transcatheter Aortic Valve Replacement (TAVR) are limited.
We utilized the nationwide inpatient sample to identify patient who underwent TAVR between November-2011 and December-2014. We compared crude and adjusted outcomes of elective vs. non-elective TAVR.
Between 2011 and 2014, 38830 patients underwent TAVR in the United States. Of these, 67% were done electively and 33% were done on a non-elective basis. The ratio of non-elective to elective TAVR seems to be increasing overtime (Figure-1). Crude and adjusted in-hospital mortality were >2-folds higher in the non-elective group (Figure-1). Incidence of post-TAVR complications, length of stay, intermediate care utilization and cost of case were also higher in the non-elective group (Table-1).
|Age- mean (SD), y||81 (9)||81 (8)||0.7|
|Transfemoral access (%)||80.5%||79.3%||0.19|
|In-Hospital Death (%)||2.5%||6.8%||<0.001|
|Permanent Pacemaker Implantation (%)||10.4%||13.3%||<0.001|
|Acute Kidney Injury Requiring Dialysis(%)||3.2%||6.7%||<0.001|
|Length of Stay- mean (SD), d||6 (5)||11 (9)||<0.001|
non-elective TAVR is associated with significant morbidity and mortality. Further studies are needed to identify possible strategies to increase the proportion of TAVR performed electively.
STRUCTURAL: Valvular Disease: Aortic