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Updated: Jun 13, 2026

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
06:04

Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation

Published on: August 8, 2025

The Clinical and Economic Consequences of Delayed Transcatheter Aortic Valve Replacement

Sreekanth Vemulapalli1, Mark Russo2, Shannon Murphy3

  • 1Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA.

Structural Heart : the Journal of the Heart Team
|June 12, 2026
PubMed

Insights

Delayed transcatheter aortic valve replacement (TAVR) significantly increases mortality risk by 50% and incurs over $36,000 in additional healthcare costs. Timely TAVR is crucial for better patient outcomes and reduced economic burden.

Area of Science:

  • Cardiology
  • Health Economics
  • Medical Interventions

Background:

  • Aortic stenosis (AS) often requires aortic valve replacement, but access delays are common.
  • The clinical and economic impact of delayed transcatheter aortic valve replacement (TAVR) for AS is not well-defined.

Purpose of the Study:

  • To investigate the clinical and economic consequences of delayed TAVR in patients with significant AS.
  • To compare outcomes between timely and delayed TAVR procedures.

Main Methods:

  • Analysis of 4069 patients undergoing TAVR between July 2019 and June 2023.
  • Categorization into timely (≤90 days) and delayed (>90 days or urgent/emergent) TAVR groups.
  • Evaluation of 3-year clinical outcomes (mortality, heart failure hospitalizations, stroke) and economic outcomes (healthcare costs, hospitalizations) using multivariable models.

Main Results:

  • Delayed TAVR patients (49.6%) had higher frailty but similar comorbidities compared to timely TAVR patients (50.4%).
  • At 3 years, delayed TAVR was linked to significantly higher composite outcomes (50.1% vs. 36.8%), mortality (19.5% vs. 13.7%), and heart failure hospitalizations (38.4% vs. 26.5%).
  • Delayed TAVR resulted in $36,740 higher healthcare costs per patient, mainly due to increased hospitalizations.

Conclusions:

  • Delayed TAVR is associated with substantially worse clinical outcomes, including a 50% increase in mortality risk.
  • Significant economic consequences arise from delayed TAVR, with excess costs exceeding $36,000 over three years.
  • Findings underscore the need for timely TAVR interventions and system-level improvements to minimize wait times.
Abstract

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