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Updated: Jun 4, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Transcatheter Aortic Valve Replacement in Aortic Stenosis Patients With New York Heart Association Functional Class
Jorge Nuche1, Jules Mesnier2, Julien Ternacle3
1Québec Heart and Lung Institute, Québec City, Québec, Canada.
Background:
Patients with symptomatic aortic stenosis are a vulnerable population with associated cardiac damage and a significant comorbidity burden. In this study we aimed to determine the rate, factors associated with, and prognostic value of poor functional status (New York Heart Association [NYHA] class III-IV) in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR).
Methods:
This multicenter study included 6363 transarterial TAVR patients, classified according to baseline functional status (NYHA class I or II vs III or IV).
Results:
A total of 3800 (60%) patients presented with NYHA class III or IV before the TAVR procedure. Atrial fibrillation (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11-1.58; P = 0.002), chronic kidney disease (CKD; OR, 1.73; 95% CI, 1.45-2.05; P < 0.001), chronic obstructive pulmonary disease (COPD; OR, 1.65; 95% CI, 1.32-2.05; P < 0.001), reduced left ventricular ejection fraction (OR, 2.28; 95% CI, 1.70-3.05; P < 0.001), and moderate and severe pulmonary hypertension were associated with a poor functional status. At 1-year follow-up, patients with NYHA class III or IV had higher rates of mortality (8.81 per 100 person-years [95% CI, 7.57-10.15] vs 13.12 per 100 person-years [95% CI, 11.80-14.58]; log rank, P < 0.001) and heart failure hospitalization (8.25 per 100 person-years [95% CI, 7.05-9.65] vs 12.5 per 100 person-years [95% CI, 11.24-14.00]; log rank, P = 0.005). Comorbidity factors (COPD, CKD) and signs of cardiac damage (atrial fibrillation, pulmonary hypertension) determined an increased risk of poorer clinical outcomes (P < 0.01 for all).
Conclusions:
More than half of the patients undergoing TAVR in the contemporary era have presented with advanced functional class before the procedure, and this was associated with a greater comorbidity and cardiac damage burden. Patients with poorer baseline functional status exhibited worse clinical outcomes at 1-year follow-up. These findings highlight the need for further study on earlier interventions for patients with aortic stenosis.
