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Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
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Transcatheter aortic valve replacement in patients with severe comorbidities: A retrospective cohort study

Liang Tang1,2, Paul Sorajja1, Michael Mooney1

  • 1Valve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|June 9, 2020
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) patients with severe comorbidities (sCM) face significantly lower survival rates. While TAVR offers limited mortality benefit for these patients, quality of life may still improve.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Transcatheter aortic valve replacement (TAVR) is a key treatment for aortic stenosis.
  • The benefits of TAVR in patients with severe comorbidities (sCM) are not well-established.
  • sCM may limit the survival and quality-of-life benefits of TAVR.

Purpose of the Study:

  • To evaluate the long-term outcomes of TAVR in patients with sCM.
  • To compare survival and quality-of-life post-TAVR between patients with and without sCM.
  • To identify risk factors associated with mortality after TAVR in patients with sCM.

Main Methods:

  • Retrospective analysis of 890 TAVR patients from January 2011 to August 2018.
  • sCM included severe lung disease, liver disease, end-stage renal disease, dementia, dilated cardiomyopathy, and frailty.
  • Comparison of outcomes between patients with (n=215) and without (n=675) sCM.

Main Results:

  • Patients with sCM had worse baseline symptoms, higher predicted mortality (STS-PROM), and lower quality of life (KCCQ).
  • Three-year all-cause mortality was significantly higher in the sCM group (40% vs. 79%).
  • The composite endpoint of mortality, heart failure re-hospitalization, myocardial infarction, or stroke was also worse in the sCM group (31% vs. 64%).
  • Quality of life (KCCQ) improved similarly in both groups post-TAVR.
  • Severe comorbidities, except liver disease, increased mortality risk; each additional comorbidity multiplied mortality risk by 2.8.

Conclusions:

  • TAVR patients with sCM experience poor 3-year survival outcomes.
  • Despite limited survival benefits, TAVR may lead to quality-of-life improvements in patients with sCM.
  • The presence of multiple severe comorbidities significantly increases mortality risk post-TAVR.
Abstract

Keywords:
aortic stenosismedical futilityoutcometranscatheter aortic valve replacement

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