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Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices

Jules Mesnier1, Julien Ternacle2, Asim N Cheema3

  • 1Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.

JACC. Cardiovascular Interventions
|September 27, 2023
PubMed

Insights

Sudden cardiac death (SCD) and advanced heart failure (HF) account for a significant portion of deaths after transcatheter aortic valve replacement (TAVR). Identifying risk factors like arrhythmias and specific procedural findings can help mitigate these risks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • The long-term burden of cardiac mortality, specifically from advanced heart failure (HF) and sudden cardiac death (SCD), following transcatheter aortic valve replacement (TAVR) is not well-established.
  • Contemporary TAVR outcomes require ongoing evaluation, particularly concerning specific causes of death.

Purpose of the Study:

  • To determine the incidence and predictors of SCD and HF-related death in patients undergoing TAVR with newer-generation devices.
  • To identify patient characteristics and procedural factors associated with increased risk of SCD and HF death post-TAVR.

Main Methods:

  • Analysis of 5,421 consecutive patients who received TAVR with balloon-expandable or self-expandable valves.
  • Median follow-up of 2 years to assess mortality causes, including cardiovascular death, advanced HF, and SCD.
  • Multivariable analysis to identify independent predictors of HF-related death and SCD.

Main Results:

  • Cardiovascular causes accounted for 50.8% of the 976 deaths (18.0% overall) within the follow-up period.
  • Advanced HF (11.6%) and SCD (7.5%) were significant contributors to mortality post-TAVR.
  • Predictors for HF death included atrial fibrillation, prior pacemaker, reduced ejection fraction, transthoracic approach, and new-onset LBBB; predictors for SCD included diabetes, CKD, valve-in-valve TAVR, nontransfemoral approach, and periprocedural ventricular arrhythmias.

Conclusions:

  • Advanced HF and SCD represent a substantial proportion of deaths after contemporary TAVR.
  • Potentially modifiable risk factors for HF death (e.g., arrhythmias, dyssynchrony) and SCD (e.g., valve-in-valve procedures, periprocedural arrhythmias) were identified.
  • These findings highlight targets for risk mitigation strategies to improve outcomes after TAVR.
Abstract

Keywords:
aortic stenosisheart failuresudden cardiac deathtranscatheter aortic valve replacement

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