Urgent Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Acute Heart Failure: Procedural and 30 Days Outcomes

Background: Transcatheter aortic-valve implantation (TAVI) is recommended for patients with severe symptomatic aortic stenosis (AS) at prohibitive/high risk for surgical aortic valve replacement (SAVR). Severe AS patients may develop acute decompensated heart failure (HF) resistant to medical therapy. Herein we report our TAVI experience in treating unstable AS patients who require urgent intervention for their aortic-valve disease.

Methods: Patients were restrictively included in the urgent-TAVI registry if they were admitted with acute HF refractory and persisting despite medical therapy and TAVI performed during the same hospital stay. All others were included in the elective-TAVI group.

Results: Between Nov-2008 and Apr-2015, 410 consecutive patients underwent TAVI at our center, 27 (6.6%) urgently. Urgent patients were more likely to be frail and to carry higher SAVR mortality risk based on STS PROM/LES measures. Pulmonary edema was the most common clinical presentation. Pre-procedural assessment used fewer imaging modalities, yet, implantation success remained high and reached 96.3% using an additional valve (within valve) required in 3 cases, with no difference in peri- procedural complications according to the VARC2 definitions. Although 30-days functional capacity was reduced, patients maintained similar 30-days mortality and major adverse cardiovascular events compare to the elective-TAVI patients.

Conclusions: Short-term outcome following urgent-TAVI appears to be reasonable. For patients with severe AS who develop acute decompensated HF recalcitrant to optimal medical therapy and are at high risk for surgical AVR, urgent-TAVI may be a viable treatment strategy. Larger prospective studies and data on long term outcome are needed.