Study Compares Outcomes of Urgent Versus Nonurgent TAVR Procedures

October 24, 2019—A study evaluating the outcomes of urgent versus nonurgent transcatheter aortic valve replacement (TAVR) procedures was published by Ayman Elbadawi, MD, et al in Catheterization and Cardiovascular Interventions (CCI). The investigators used the Nationwide Inpatient Sample database for years 2011–2014 to identify hospitalizations for TAVR in the urgent setting. Propensity score matching was used to compare patients who underwent TAVR in nonurgent versus urgent settings.

In this large nationwide analysis, the investigators found that approximately a quarter of TAVR procedures were performed in urgent settings. They reported that urgent TAVR was associated with higher mortality and increased complications compared with nonurgent TAVR; however, the absolute difference in in‐hospital mortality was not remarkably higher. Thus, urgent TAVR can be considered as a reasonable approach when indicated, concluded investigators in CCI.

Of the 42,154 hospitalizations in which TAVR was performed, 10,114 (24%) procedures were urgent. There was an uptrend in the rate of urgent TAVR procedures (P = .001).

As summarized in CCI, the rates of in‐hospital mortality among this group did not change during the study period (P = .713).

Nonurgent versus urgent TAVR was associated with lower incidences of:

• Mortality (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.69–0.89; P < .001)
• Cardiogenic shock (OR, 0.46; 95% CI, 0.40–0.53; P < .001)
• Use of mechanical circulatory support devices (OR, 0.69; 95% CI, 0.59–0.82; P < .001)
• Acute kidney injury (OR, 0.6; 95% CI, 0.56–0.64; P < .001)
• Hemodialysis (OR, 0.67; 95% CI, 0.56–0.8; P < .001)
• Major bleeding (OR, 0.94; 95% CI, 0.89–0.99; P = .045)

Also, nonurgent versus urgent TAVR showed shorter lengths of stay (7.08 ± 6.317 vs 12.39 ± 9.737 days; P < .001).

There was no difference in:

• Acute stroke (OR, 0.96; 95% CI, 0.81–1.14; P = .636),
• Vascular complications (OR, 1.07; 95% CI, 0.89–1.29; P = .492)
• Pacemaker insertions (OR, 0.92; 95% CI, 0.84–1.01; P = .067).

Among those patients undergoing urgent TAVR, subgroup analysis showed higher mortality in patients age ≤ 80 years (P = .033), women (P < .001), and patients with chronic kidney disease (P = .001), heart failure (P < .001), and liver disease (P = .003).