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Transcatheter Aortic Valve Replacement Wait-list Failure-Correlation With Cardiac Damage Stage

Itamar Loewenstein1, Aviram Hochstadt2, Tami Jacoby1

  • 1Cardiology Department, Tel-Aviv Sourasky Medical Center, Affiliated to The Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel.

The Canadian Journal of Cardiology
|August 15, 2025
PubMed

Insights

Cardiac damage staging predicts adverse events in patients awaiting Transcatheter aortic valve replacement (TAVR). Advanced stages indicate higher risk of hospitalization and mortality, aiding TAVR candidate prioritization.

Area of Science:

  • Cardiology
  • Echocardiography
  • Interventional Cardiology

Background:

  • Growing waitlists for Transcatheter aortic valve replacement (TAVR) highlight the need for effective candidate prioritization.
  • Aortic stenosis (AS)-related cardiac damage (CD) staging offers a framework to assess structural damage in AS patients.
  • Adverse events can occur while patients await TAVR, emphasizing the urgency for improved risk stratification.

Purpose of the Study:

  • To evaluate the correlation between cardiac damage (CD) staging and AS-related adverse events in patients awaiting TAVR.
  • To determine if CD staging can predict waitlist failure (WF) in this patient population.

Main Methods:

  • A cohort of 904 patients with symptomatic severe AS undergoing TAVR evaluation between 2018-2022 was analyzed.
  • Waitlist failure (WF), defined as AS-related hospitalizations or mortality, was the primary outcome.
  • Multivariable logistic regression identified predictors of WF, including CD staging, frailty, and hypoalbuminemia.

Main Results:

  • Waitlist failure (WF) occurred in 8.0% of patients.
  • Higher CD stages on echocardiography correlated with an increased risk of WF.
  • CD staging was an independent predictor of WF (continuous: HR 1.66; categorical stage ≥3: HR 2.24), alongside frailty and hypoalbuminemia.

Conclusions:

  • Advanced cardiac damage (CD) stage is a significant independent predictor of adverse events, including hospitalization and mortality, in patients awaiting TAVR.
  • CD staging provides valuable information for prioritizing TAVR candidates and managing waitlist risks.
  • Integrating CD staging into clinical practice can help optimize TAVR candidate selection and improve patient outcomes.
Abstract

Keywords:
Transcatheter aortic valve replacementcardiac damage stagehospitalizationprioritizationwait-list failurewaiting time

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