Out-of-Hospital 30-Day Mortality After Transfemoral TAVR Evaluated in TVT Registry

February 8, 2021—Saif Anwaruddin, MD, et al conducted an analysis of the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry that sought to better understand out-of-hospital 30-day mortality after transfemoral transcatheter aortic valve replacement (TAVR) and identify factors associated with poor outcomes. The findings were published in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2021;14:261-274).

The study examined patients in the STS/ACC TVT Registry undergoing TAVR for severe aortic stenosis from January 2015 to March 2018. Primary and secondary endpoints were 30-day out-of-hospital all-cause mortality and out-of-hospital cardiovascular mortality, respectively. Logistic regression models were used to assess association between prespecified factors and endpoints.

As summarized in JACC: Cardiovascular Interventions, there were 106,749 patients who underwent TAVR and were eligible for analysis. Transfemoral TAVR was performed in 92.3% of patients. A total of 2,137 (2.2%) transfemoral patients died within 30 days of the procedure, and 623 (29%) of these patients experienced out-of-hospital 30-day mortality.

Cardiovascular and pulmonary etiologies accounted for the majority of observed mortality. Multivariable regression analysis identified the following as being independently associated with the primary endpoint: older age, gender, lower-body surface area, lower left ventricular ejection fraction, lower hemoglobin, atrial fibrillation or flutter, severe lung disease, home oxygen use, lack of moderate-to-severe aortic insufficiency, urgent TAVR, lower Kansas City Cardiomyopathy Questionnaire score, longer hospital length of stay, and in-hospital complications. New onset or pre-existent atrial fibrillation or flutter was also independently associated with 30-day out-of-hospital cardiovascular mortality in the transfemoral population.

The investigators identified a 30-day all-cause mortality rate for TAVR of 2.2%. Approximately one-third of patients experienced out-of-hospital mortality at 30 days. Several factors were identified as being independently associated with 30-day out-of-hospital all-cause and cardiovascular mortality. Further work is needed to understand how best to improve out-of-hospital mortality after TAVR, concluded the investigators in JACC: Cardiovascular Interventions.