Author + information
- Tobias Schmidt1,
- Mintje Bohné1,
- Michael Schlüter2,
- Jury Schewel1,
- Michael Schmoeckel1,
- Karl-Heinz Kuck1 and
- Christian Frerker1
Transcatheter aortic valve replacement (TAVR) is recommended for surgical high-risk or even intermediate risk patients with symptomatic severe aortic stenosis (AS). Patients may experience acute heart failure (HF) due to AS. There is only limited data on clinical presentation before TAVR and related outcome. To evaluate 30-day and one-year outcome after Transcatheter Aortic Valve Replacement (TAVR) in patients with versus without signs of acute heart failure at time of admission.
Between May 2013 and April 2015, 484 patients underwent a Transcatheter Aortic Valve replacement (TAVR) procedure at a single center. 176 patients showed no signs of acute HF at time of admission (group 1), whereas 196 patients showed signs of acute HF (group 2) due to 2016 ESC guidelines for treatment of acute and chronic heart failure. Exclusion criteria were non-femoral access (n=66), severe aortic regurgitation as indication for TAVR (n=9), missing data (n=26) and emergency TAVR in cardiogenic shock (n=11).
30-day mortality (1% vs. 10%; p≤0.0001) and one-year mortality (9% vs. 23%; p=0.0007) were significantly lower in patients with no signs of acute HF. Significant differences can although be reported for hospital stay (12±6.4 vs. 15±6.8 days; p≤0.0001), time on intensive care unit (ICU) (1±1.4 vs. 3±4.9 days; p≤0.0001), bleeding (11% vs. 21%; p=0.0118) and acute kidney injury (6% vs. 16%; p=0.0025). TAVR device success was high in both groups (97% both; p=0.76). There were no significant differences for stroke (5% vs. 4%; p=0.79), vascular complication (9% vs. 10%; p=0.73), coronary obstruction (0% in both groups; p=1) and pacemaker implantation rate (14% vs. 11%; p=0.44).
TAVR in patients with signs of acute HF at time of admission is related to significantly higher 30-day mortality, one-year mortality, longer ICU stay and longer overall hospitalization. Severe AS might be cause to worsening or new onset of HF, therefore patients diagnosed with a severe AS should be treated semi-urgently, best before occurrence of symptom of HF.
STRUCTURAL: Valvular Disease: Aortic