Urgent vs non-urgent transcatheter aortic valve implantation outcomes. (14th October 2021)

• Record Type: Journal Article
• Authors: Castelo, A; Grazina, A; Mendonca, T; Rodrigues, I; Garcia Bras, P; Vaz Ferreira, V; Ramos, R; Fiarresga, A; Cacela, D; Cruz Ferreira, R
• Is Part Of: European heart journal. Volume 42(2021)Supplement 1
• Publication Date: 2021-10-14
• Subjects: Aortic Valve Intervention; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehab724.2167
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Background: There are limited data about the outcomes of non-elective transcatheter aortic valve implantation (TAVI), but some studies suggest that these patients have worst results. Purpose: To compare outcomes in patients submitted to urgent versus elective TAVI. Methods: Retrospective analysis of consecutive patients (P) submitted to TAVI between 2018 and 2020 in a tertiary center. Baseline characteristics and outcomes after the procedure were collected. Urgent TAVIwas considered when patients were not electively admitted for the procedure but required the intervention on the current admission for medical reasons and could not be sent home without a definitive procedure. Results: A total of 208P (55, 3% female) were included, with a mean age of 82±7 years. Patients submitted to urgent TAVI (57P, 27, 4%) had worse baseline characteristics, with higher EuroScore risk (10, 7% vs 5, 4%, p<0, 001), STS score (7, 3% vs 4, 4%, p<0, 001), and natriuretic peptide B (1350 vs 728 pg/mL, p=0, 021), lower left ventricle ejection fraction (44% vs 50%, p<0, 001), more diabetes (49, 1% vs 33, 1%, p=0, 033), peripheral artery disease (22, 8% vs 4, 6%, p<0, 001) and worse accesses (21, 2% vs 5%, p=0, 002). In univariable analysis, urgent TAVI was associated with higher intra-hospital mortality (14% vs 4%, p=0, 01), 30-days mortality (17, 5% vs 4%, p=0, 001) and 30-days cardiovascular mortality (17, 5% vs 3, 3%, p<0, 001), life- threatening bleeding (17, 9% vs 4%, p=0, 001), acute kidney injury (16, 1% vs 4, 7%, p=0, 007), vascular complications (16, 1 vs 4%, p=0, 003) and longer hospital and intensive care unit stay (30 vs 12 days, p<0, 001 and 6 vs 4 days, p=0, 025 respectively), but not with post-TAVI hospital stay (12 vs 10 days, p=0, 37). When adjusted to the differences in baseline characteristics, in a multivariable analysis, urgent TAVI was only associated with longer hospital stay (p<0, 0001). There were no differences in outcomes between groups beyond the first 30 days after the procedure, including mortality and hospital admissions. Conclusion: Patients submitted to urgent TAVI tend to have worse short-term outcomes, but this seems to be attributable to the worse baseline characteristics of these cases instead of the urgent nature of the procedure. Even with the adjustment for baseline differences, these patients have longer global hospital stays, but they don't have latter post-TAVI discharge. Funding Acknowledgement: Type of funding sources: None.