About one-third of deaths within 30 days of transfemoral TAVR occur out of the hospital, according to a study published Feb. 1 in JACC: Cardiovascular Interventions.

Saif Anwaruddin, MD, FACC, et al., used data from the STS/ACC TVT Registry to examine out-of-hospital 30-day mortality following transfemoral TAVR and identify factors associated with poor outcomes. The researchers looked at 106,749 patients undergoing TAVR for severe aortic stenosis between 2015 and 2018. The primary endpoint was 30-day out-of-hospital all-cause mortality following transfemoral TAVR, while the secondary outcome was 30-day out-of-hospital cardiovascular mortality.

Of the total population, 98,578 (92.3%) underwent transfemoral TAVR. Of these, 2,137 (2.2%) died within 30 days of the procedure, with 623 deaths (29%) occurring out of the hospital. The majority of deaths were attributed to cardiovascular (50.1% for in-hospital and 37.7% for out-of-hospital) and pulmonary (13.3% for in-hospital and 18.6% for out-of-hospital) factors. Other factors associated with the primary outcome include older age, male sex, lower body surface area, lower left ventricular ejection fraction (LVEF), lower hemoglobin, atrial fibrillation or flutter, and severe lung disease. Factors associated with higher risk of out-of-hospital 30-day cardiovascular mortality included age greater than 80 years, lower LVEF, current dialysis, and longer length of stay.

According to the researchers, it "remains concerning" that out-of-hospital mortality accounts for about one-third of all deaths within 30 days following transfemoral TAVR. The overall 30-day mortality following transfemoral mortality is 2.2%, including both in-hospital and out-of-hospital events, with cardiovascular and pulmonary causes accounting for the majority of death within 30 days, they note. Additional research is needed to "better characterize patients at risk of 30-day out-of-hospital mortality after TAVR and to develop interventions to mitigate this risk," they conclude.

The study "successfully highlighted our limited understanding of early out-of-hospital mortality following TAVR," Anita W. Asgar, MD, FACC, and Laurent Jamart, MD, write in an accompanying editorial comment. "As TAVR attains new heights striving for continued success, it is important to remember that which we still do not understand and accept that sometimes we may need to 'take the stairs,'" they conclude.

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

Keywords: Stroke Volume, Transcatheter Aortic Valve Replacement, Atrial Fibrillation, Body Surface Area, Hospital Mortality, Length of Stay, Ventricular Function, Left, Renal Dialysis, Aortic Valve Stenosis, Registries, Hospitals, Hemoglobins, Lung Diseases, National Cardiovascular Data Registries, STS/ACC TVT Registry

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