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

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.