STS/ACC TVT Registry: Aborted Elective TAVR Procedures Decline With Advances

The incidence of aborted transcatheter aortic valve replacement (TAVR) elective procedures has significantly declined in recent years, along with the evolution of TAVR and greater operator experience, according to study results published Sept. 16 in JACC: Cardiovascular Interventions. Thirty-day outcomes were worse when TAVR was aborted.

Jennifer A. Rymer, MD, MBA, et al., analyzed data from 106,169 patients at 524 U.S. hospitals in the STS/ACC TVT Registry who had a first elective TAVR procedure between Nov. 11, 2011 and June 30, 2017 and a complete data set. A total of 1,150 procedures (1.1 percent) were aborted. Of these, 581 (50.5 percent) were aborted because of device limitations (ADs) and 569 (49.5 percent) were aborted for other reasons.

More women than men had aborted elective procedures and women often had a history of PAD, chronic lung disease and advanced chronic kidney disease. Over the full study period, factors associated with aborted procedures included PAD, home oxygen use, nonfemoral access site and lower institutional TAVR volume. Factors associated with ADs were diabetes, PAD, alternative access and lower institutional TAVR volume.

The observed rate of 30-day death or stroke among patients who had aborted procedures was 25.2 percent, compared with 6.0 percent for patients who did not; the adjusted odds ratio (OR) was 5.02. The observed rate of 30-day vascular complications or bleeding events was 36.4 percent for patients who had aborted procedures vs. 9.8 percent for patients who did not; adjusted OR, 3.70.

"Our study represents the only contemporary U.S. data on aborted TAVR procedures," write the authors. They state they found a significant decrease in overall aborted procedures, from 3.9 percent in 2011-2012 to 0.7 percent in 2017.

"As TAVR technology continues to evolve with expanding indications, further studies are needed to better predict and prevent aborted procedures so as to optimize patient outcomes," they conclude.

In a related editorial comment, Heath S.L. Adams, BMedSci, MBBS, et al., add that "In the future, it is likely that smaller sheath sizes and improved transcatheter heart valve delivery systems will further reduce the likelihood of aborted TAVR procedures, and thereby convey lower procedural risk to the patient. Furthermore, low volume centers should be encouraged to refer challenging cases to more experienced centers where a range of technical expertise and back-up facilities are more likely to be available."

Keywords: National Cardiovascular Data Registries, Registries, STS/ACC TVT Registry, Aortic Valve, Transcatheter Aortic Valve Replacement, Heart Valve Prosthesis, Stroke, Diabetes Mellitus, Renal Insufficiency, Chronic, Lung Diseases, Oxygen

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