Clinical Outcomes at 1 Year Following TAVR | Journal Scan

Study Questions:

What are the 1-year outcomes of transcatheter aortic valve replacement (TAVR) in the United States?

Methods:

This study included 12,182 patients undergoing TAVR at 299 hospitals in the United States, and examined rates and predictors of adverse events. The authors examined data from the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry linked to Medicare and Medicaid Services claims data.

Results:

Median age was 84 years, 48% were men, and the median STS-predicted mortality was 7.1%. Mortality following TAVR was 7.0% at 30 days. At 1 year, the mortality rate was 23.7%, stroke rate was 4.1%, and the combined rate of stroke and mortality was 26.0%. Among survivors, 46.8% of patients were not re-hospitalized within 12 months. Variables independently associated with increased mortality at 1 year included advanced age (increased for each age group over 75 years), male gender (hazard ratio [HR], 1.2), end-stage renal disease (HR, 1.7), severe chronic obstructive pulmonary disease (HR, 1.4), nontransfemoral access (HR, 1.4), STS score >15% versus <8% (HR, 1.8), and preoperative atrial fibrillation/flutter (HR, 1.4).

Conclusions:

Among patients treated with TAVR in the United States, more than 25% experience death or stroke within 1 year, while the majority of survivors are re-hospitalized at least once during that time.

Perspective:

These results demonstrate real-world outcomes in patients treated with TAVR in the United States. This large registry reports rates of mortality and other adverse events that are similar to results from other populations. Nevertheless, rates of adverse events remain high. While TAVR clearly improves outcomes and symptoms in many individuals, there are also many patients who do not experience a significant benefit or who may even experience harm. Over 25% of patients experience death or stroke at 1 year, and the majority of survivors are re-hospitalized during this period. These results demonstrate that we need to improve our ability to identify which patients are most likely to benefit from TAVR. This study identifies several variables associated with risk of mortality, and we need to use the results from this and other studies to develop a better approach to patient selection for this procedure.

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease

Keywords: Transcatheter Aortic Valve Replacement, Stroke, Cardiac Surgical Procedures, Hospitals, Mortality, Atrial Fibrillation, Kidney Failure, Chronic, Pulmonary Disease, Chronic Obstructive, Registries, Risk, Survivors, Heart Valve Diseases


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