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. 2023 Sep 1;62(17):2457-2463.
doi: 10.2169/internalmedicine.0638-22. Epub 2023 Feb 1.

Short-term Outcomes of Urgent Transcatheter Aortic Valve Replacement in Symptomatic Aortic Stenosis That Requires Emergency Hospital Admission

Hitomi Horinouchi  1 , Tomoo Nagai  1 , Yohei Ohno  1 , Junichi Miyamoto  1 , Tsutomu Murakami  1 , Norihiko Kamioka  1 , Koichiro Yoshioka  1 , Yuji Ikari  1
Affiliations

Short-term Outcomes of Urgent Transcatheter Aortic Valve Replacement in Symptomatic Aortic Stenosis That Requires Emergency Hospital Admission

Hitomi Horinouchi et al. Intern Med. .

Abstract

Objective This study retrospectively compared the outcomes of emergently admitted patients with aortic stenosis (AS) with or without urgent transcatheter aortic valve replacement (TAVR). Methods Patients hospitalized between February 2015 and December 2019 for symptomatic AS were retrospectively analyzed by comparing the received conservative management [continued medical therapy with or without elective surgical transcatheter replacement (SAVR) or TAVR scheduled after the index hospitalization] and urgent TAVR (TAVR during the index hospitalization). Results The cohort comprised 114 patients with symptomatic AS who required emergency admission. Urgent TAVR was performed for 37 patients, while conservative management was provided for 77 patients, including 1 who received urgent SAVR. Urgent TAVR was more likely to be performed in patients with a history of hospitalization for heart failure, high New York Heart Association class scores, a lower clinical frailty scale at admission, and a high aortic valve peak velocity (p=0.01, p<0.001, p<0.01 and p=0.02, respectively). Kaplan-Meier analyses with log-rank test revealed favorable outcomes of urgent TAVR in all-cause mortality and cardiovascular events within 60 days of admission (p<0.01, p<0.01, respectively). Conclusion Urgent TAVR had better short-term outcomes in patients with symptomatic AS who required emergency hospital admission than conservative management. When considering urgent TAVR, patients with typical heart failure symptoms due to AS with a history of heart failure hospitalization and relatively little frailty can be selected.

Keywords: aortic stenosis; outcome; transcatheter aortic valve replacement.

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Conflict of interest statement

Author's disclosure of potential Conflicts of Interest (COI).

Yohei Ohno: proctor, Medtronic. Norihiko Kamioka: proctor, Edwards Life Sciences.

Figures

Figure 1.
Figure 1.
Frequency of conservative management and urgent transcatheter aortic valve replacement in patients with emergency admission due to symptomatic aortic stenosis. TAVR: transcatheter aortic valve replacement
Figure 2.
Figure 2.
Cumulative survival probability plots of urgent transcatheter aortic valve replacement and conservative management using the Kaplan-Meier method. A: All-cause mortality within 60 days after admission in raw data. B: Cardiac event within 60 days after admission. CS: conservative management, TAVR: transcatheter aortic valve replacement, UT: urgent transcatheter aortic valve replacement
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