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Impact of Preoperative Diuretics Treatment on Long-Term Clinical Outcomes After Transcatheter Aortic Valve

Shun Hirosawa1, Hiroaki Yokoyama1, Ken Yamazaki1

  • 1Department of Cardiology, Hirosaki University Graduate School of Medicine.

International Heart Journal
|February 1, 2026
PubMed

Insights

Preoperative diuretic use in severe aortic stenosis patients undergoing transcatheter aortic valve implantation is linked to worse long-term outcomes. This study found higher mortality rates in patients treated with diuretics before TAVI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Outcomes Research

Background:

  • Diuretics are commonly used to manage congestive symptoms in severe aortic stenosis (AS).
  • The impact of pre-TAVI diuretic treatment on long-term outcomes in AS patients remains under investigation.
  • Transcatheter aortic valve implantation (TAVI) is a key treatment for severe AS.

Purpose of the Study:

  • To evaluate the effect of preprocedural diuretic treatment on clinical outcomes in patients undergoing TAVI.
  • To determine if pre-TAVI diuretic use is an independent predictor of mortality after TAVI.

Main Methods:

  • Prospective enrollment of 4,903 consecutive AS patients undergoing TAVI across 7 Japanese hospitals (April 2010 - June 2024).
  • Patients were categorized into Diuretics (n=2,073) and Non-Diuretics (n=2,830) groups based on pre-TAVI treatment.
  • Propensity score matching was employed to adjust for confounding factors and assess mortality outcomes over a median 2.1-year follow-up.

Main Results:

  • The Diuretics group exhibited higher rates of comorbidities, poorer NYHA classification, reduced LVEF, and impaired renal function.
  • Patients receiving preprocedural diuretics had significantly worse all-cause (38% vs. 26%) and cardiovascular mortality (18% vs. 10%) compared to the Non-Diuretics group (P < 0.001).
  • Post-propensity score matching, pre-TAVI diuretic treatment remained an independent predictor of worse all-cause (HR: 1.29) and cardiovascular mortality (HR: 1.61).

Conclusions:

  • Approximately 40% of AS patients undergoing TAVI received preoperative diuretics.
  • Preprocedural diuretic treatment is associated with significantly worse long-term all-cause and cardiovascular mortality after TAVI.
  • Preoperative diuretic use is an independent predictor of adverse outcomes following TAVI in severe AS patients.

Keywords:
Aortic stenosisDiureticsHeart failureStructural heart disease

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