Procedural and remote outcome among patients undergoing urgent trans-catheter aortic valve implantation - The 67th Annual Conference of the Israel Heart Society

Anat Berkovitch ^1,2 Amit Segev ^1,2 Ariel Finkelstein ^2,3 Ran Kornowski ^2,4 Haim Danenberg ⁵ Paul Fefer ^1,2 Hana Vaknin Assa ^2,4 Maayan Konigstein ^2,3 Gidon Perlman ⁵ Elad Maor ^1,2 David Planer ⁵ Katia Orvin ^2,4 Arie Steinvil ^2,3 Mony Shuvy ⁵ Amir Halkin ^2,3 Abid R Assali ^2,4 Victor Guetta ^1,2 Israel M. Barbash ^1,2

¹Division of Cardiology, Leviev Heart and Vascular Center, Chaim Sheba Medical Center, Tel Hashomer, Israel, Israel
²Sackler School of Medicine, Tel-Aviv University, Israel
³Division of Cardiology, Tel Aviv Medical Center, Tel Aviv, Israel
⁴Division of Cardiology, Rabin Medical Center, Petach-Tikva, Israel
⁵The Heart Institute, Hadassah Ein-Karem Medical Center, The Hebrew University, Jerusalem, Israel

Background: Severe aortic stenosis patients suffer frequent heart failure decompensations events often requiring hospitalization. In extreme situations patients can be found with pulmonary edema and cardiogenic shock, unresponsive to medical treatment. Urgent trans-catheter aortic valve implantation (TAVI) has emerged as a treatment option for these high-risk patients.

Methods: We investigated 3,599 patients undergoing TAVI. Subjects were divided into two groups based on procedure urgency: patients who were electively hospitalized for the procedure (N=3,448) and those who had an urgent TAVI (N=151). Peri-procedural complications were documented according to the VARC-2 criteria. In hospital and 1-year mortality rates were prospectively documented.

Results: Mean age of the study population was 82±7, of whom 52% were female. Peri-procedural complication rates was significantly higher among patients with an urgent indication for TAVI compared to those having an elective procedure: valve malposition 3.6% vs. 0.6% (p-value=0.023), valve migration 3.2% vs. 0.9% (p-value=0.016), post procedure myocardial infarction 3.7% vs. 0.3% (p-value=0.004), and stage 3 acute kidney injury 2.6% vs. 0.5%, (p-value=0.02). Univariate analysis found that patients with urgent indication for TAVI had significantly higher in hospital mortality (5.8% vs. 1.4%, p-value<0.001). Similarly, multivariate analysis adjusted for age, gender and cardio-vascular risk factors found that patients with urgent indication had more than 5-folds increased risk of in-hospital mortality (OR 5.94, 95% CI 2.28-15.43, p-value<0.001). Kaplan-Meier’s survival analysis showed that patients undergoing urgent TAVI had higher 1-year mortality rates compared to patients undergoing an elective TAVI procedure (p-value log-rank<0.001, Figure). Multivariate analysis found they had more than 2-folds increased risk of mortality at 1-year (HR 2.27, 95% CI 1.53-3.38, p

Conclusions: Patients with urgent indication for TAVI have higher in-hospital mortality and higher peri-procedural complication rates. However, if these patients survive the index hospitalization, they enjoy good prognosis.

Kaplan-Meier`s survival analysis