Temporal Trends in 1-Year Cause-Specific Mortality After TAVR: Insights From the STS/ACC TVT Registry

The impact of changing patient demographics and risk profiles on cause-specific mortality after transcatheter aortic valve replacement (TAVR) remains unclear.

The aim of this study was to examine causes of death (CoDs) and temporal trends and predictors of cause-specific mortality after TAVR.

Data from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were analyzed to identify patients who underwent isolated TAVR between January 2012 and October 2022 who had available information on 1-year CoD. The primary outcome was cause-specific (cardiac and noncardiac) mortality at 1 year. Fine and Gray subdistribution hazard models were used to account for the competing risk for cause-specific death.

Of 36,877 patients who died within 1 year after TAVR and had available information on CoD, 11,560 (31.3%) had cardiac death and 25,317 (68.7%) had noncardiac death. There was an initial decline in the risk-adjusted hazards of 1-year cardiac and noncardiac death after TAVR from 2012 to 2017 (adjusted HR per year: 0.95 [95% CI: 0.92-0.97] and 0.92 [95% CI: 0.90-0.93], respectively), followed by an increase from 2018 to 2022 (adjusted HR per year: 1.07 [95% CI: 1.05-1.09] and 1.22 [95% CI: 1.20-1.24], respectively). Age >80 years, comorbidities, poor functional status, nonelective procedure, nonfemoral access, and in-hospital complications were identified as independent predictors of both cardiac and noncardiac death after TAVR.

Noncardiac causes account for two-thirds of deaths within 1 year after TAVR. Further studies are needed to examine whether the COVID-19 pandemic, the rapid expansion in the number of TAVR sites, or other patient and hospital characteristics contributed to the increased risk for cardiac and noncardiac death after TAVR in recent years.