Author + information
- Received August 26, 2014
- Revision received October 28, 2014
- Accepted November 4, 2014
- Published online February 10, 2015.
- Marina Urena, MD∗,
- John G. Webb, MD†,
- Helene Eltchaninoff, MD‡,
- Antonio J. Muñoz-García, MD, PhD§,
- Claire Bouleti, MD, PhD‖,
- Corrado Tamburino, MD¶,
- Luis Nombela-Franco, MD#,
- Fabian Nietlispach, MD, PhD∗∗,
- Cesar Moris, MD††,
- Marc Ruel, MD‡‡,
- Antonio E. Dager, MD§§,
- Vicenç Serra, MD‖‖,
- Asim N. Cheema, MD¶¶,
- Ignacio J. Amat-Santos, MD##,
- Fabio Sandoli de Brito, MD∗∗∗,
- Pedro Alves Lemos, MD†††,
- Alexandre Abizaid, MD‡‡‡,
- Rogério Sarmento-Leite, MD§§§,
- Henrique B. Ribeiro, MD∗,
- Eric Dumont, MD∗,
- Marco Barbanti, MD†,¶,
- Eric Durand, MD‡,
- Juan H. Alonso Briales, MD§,
- Dominique Himbert, MD‖,
- Alec Vahanian, MD‖,
- Sebastien Immè, MD¶,
- Eulogio Garcia, MD#,
- Francesco Maisano, MD∗∗,
- Raquel del Valle, MD††,
- Luis Miguel Benitez, MD§§,
- Bruno García del Blanco, MD‖‖,
- Hipólito Gutiérrez, MD##,
- Marco Antonio Perin, MD∗∗∗,
- Dimytri Siqueira, MD‡‡‡,
- Guilherme Bernardi, MD§§§,
- François Philippon, MD∗ and
- Josep Rodés-Cabau, MD∗∗ ()
- ∗Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
- †St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
- ‡Hôpital Charles Nicolle, University of Rouen, Rouen, France
- §Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
- ‖Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
- ¶Ferrarotto Hospital, University of Catania, Catania, Italy
- #Hospital Universitario Clínico San Carlos, Madrid, Spain
- ∗∗University Heart Center, Transcatheter Valve Clinic, University Hospital Zurich, Zurich, Switzerland
- ††Hospital Universitario Central de Asturias, Oviedo, Spain
- ‡‡Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
- §§Clìnica de Occidente de Cali, Valle del Cauca, Colombia
- ‖‖Hospital Universitari Vall d’Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
- ¶¶St. Michael’s Hospital, Toronto University, Toronto, Ontario, Canada
- ##Hospital Clinico Universitario de Valladolid, Valladolid, Spain
- ∗∗∗Hospital Israelita Albert Einstein, São Paulo, Brazil
- †††Heart Institute-InCor, University of São Paulo, São Paulo, Brazil
- ‡‡‡Instituto Dante Pazzanese de Cardiologia, São Paulo, Brazil
- §§§Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, Brazil
- ↵∗Reprint requests and correspondence:
Dr. Josep Rodés-Cabau, Quebec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, G1V 4G5 Quebec City, Quebec, Canada.
Background Little evidence exists of the burden and predictors of cardiac death after transcatheter aortic valve replacement (TAVR).
Objectives The purpose of this study was to assess the incidence and predictors of cardiac death from advanced heart failure (HF) and sudden cardiac death (SCD) in a large patient cohort undergoing TAVR.
Methods The study included a total of 3,726 patients who underwent TAVR using balloon (57%) or self-expandable (43%) valves. Causes of death were defined according to the Valve Academic Research Consortium–2.
Results At a mean follow-up of 22 ± 18 months, 155 patients had died due to advanced HF (15.2% of total deaths, 46.1% of deaths from cardiac causes) and 57 had died due to SCD (5.6% of deaths, 16.9% of cardiac deaths). Baseline comorbidities (chronic obstructive pulmonary disease, atrial fibrillation, left ventricular ejection fraction ≤40%, lower mean transaortic gradient, pulmonary artery systolic pressure >60 mm Hg; p < 0.05 for all) and 2 procedural factors (transapical approach, hazard ratio [HR]: 2.38, 95% confidence interval [CI]: 1.60 to 3.54; p < 0.001; presence of moderate or severe aortic regurgitation after TAVR, HR: 2.79, 95% CI: 1.82 to 4.27; p < 0.001) independently predicted death from advanced HF. Left ventricular ejection fraction ≤40% (HR: 1.93, 95% CI: 1.05 to 3.55; p = 0.033) and new-onset persistent left bundle-branch block following TAVR (HR: 2.26, 95% CI: 1.23 to 4.14; p = 0.009) were independently associated with an increased risk of SCD. Patients with new-onset persistent left bundle-branch block and a QRS duration >160 ms had a greater SCD risk (HR: 4.78, 95% CI: 1.56 to 14.63; p = 0.006).
Conclusions Advanced HF and SCD accounted for two-thirds of cardiac deaths in patients after TAVR. Potentially modifiable or treatable factors leading to increased risk of mortality for HF and SCD were identified. Future studies should determine whether targeting these factors decreases the risk of cardiac death.
- aortic stenosis
- heart failure
- sudden cardiac death
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
Dr. Urena is supported by a research PhD grant from Laval University-Quebec. Drs. Webb, Eltchaninoff, and Dumont are consultants for Edwards Lifesciences. Dr. Tamburino is consultant for Edwards Lifesciences, Medtronic, CeloNova, and Abbott. Dr. Nietlispach has served as a consultant for Edwards Lifesciences and St. Jude Medical; and has received Jude Medical; and has received speakers fees from Biotronik. Dr. Moris has served as a proctor and advisor for Medtronic. Dr. Ruel has served as a proctor for Medtronic; and has received a research grant from Edwards Lifesciences. Dr. Amat-Santos is supported by the Insituto de Salud Carlos III through a Rio Hortega contract. Dr. de Brito has served as a proctor for Edwards Lifesciences and Medtronic. Dr. Ribeiro is supported by a research PhD grant from “CNPq, Conselho Nacional de Desenvolvimento Científico e Tecnológico–Brasil.” Dr. Sarmento-Leite has served as a proctor for Medtronic CoreValve implantation. Dr. Himbert is a consultant for Edwards Lifesciences; and has served as a proctor for Edwards Lifesciences and Medtronic. Dr. Vahanian has received speakers fees from Edwards Lifesciences and Abbott; and has served on the advisory board of Valtech. Dr. Maisano has served as a consultant to Abbott Vascular, Medtronic, St. Jude Medical, and Valtech Cardio; has received royalties from Edwards Lifesciences; and is a co-founder of 4Tech. Dr. Rodés-Cabau is a consultant for Edwards Lifesciences and St. Jude Medical; and has received a research grant from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received August 26, 2014.
- Revision received October 28, 2014.
- Accepted November 4, 2014.
- American College of Cardiology Foundation