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Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement.

Publication ,  Journal Article
Rymer, JA; Xiang, Q; Wang, A; Cohen, DJ; Desai, ND; Kirtane, AJ; Hughes, GC; Harrison, JK; Kosinski, AS; Vemulapalli, S
Published in: JACC Cardiovasc Interv
September 23, 2019

OBJECTIVES: This study sought to evaluate the outcomes and factors associated with aborted procedures among patients undergoing elective transcatheter aortic valve replacement (TAVR). BACKGROUND: Elective TAVR procedures can be aborted because of device limitations or aborted for other reasons, including patient and procedural factors. Little is known about 30-day outcomes and factors associated with aborted procedures and procedures aborted because of device limitations (ADs). METHODS: Patients undergoing elective TAVR procedures from 2011 to 2017 in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were examined. The incidence of aborted procedures, both ADs and procedures aborted for other reasons (AOs), was examined. Rates of 30-day all-cause death or stroke and a composite of vascular complications and bleeding events were compared between patients with and those without aborted procedures and between patients with ADs and those with AOs. Multivariate modeling identified factors associated with aborted procedures and ADs. RESULTS: Among 106,169 patients who underwent TAVR between 2011 and 2017, procedures were aborted in 1,150 (1.1%) (581 ADs and 569 AOs). Patients with aborted procedures were more likely female with peripheral artery disease and more often treated at lower volume centers compared with those with nonaborted procedures (p < 0.01 for all). The incidence of aborted procedures and ADs decreased over the study period (p < 0.01). The adjusted rates of 30-day death and stroke were greater for aborted versus nonaborted procedures (odds ratio: 5.02; 95% confidence interval: 4.13 to 6.11). Peripheral artery disease, alternative access, and low institutional TAVR volume were factors associated with aborted procedures and ADs (p < 0.05 for all). CONCLUSIONS: The incidence of aborted procedures is declining, but peripheral artery disease and low institutional TAVR volume remain associated with aborted procedures. A thorough pre-procedural assessment and referral of challenging cases to high-volume centers may be strategies to minimize aborted procedures.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

September 23, 2019

Volume

12

Issue

18

Start / End Page

1768 / 1777

Location

United States

Related Subject Headings

  • United States
  • Treatment Failure
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Postoperative Complications
  • Peripheral Arterial Disease
 

Citation

APA
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ICMJE
MLA
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Rymer, J. A., Xiang, Q., Wang, A., Cohen, D. J., Desai, N. D., Kirtane, A. J., … Vemulapalli, S. (2019). Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv, 12(18), 1768–1777. https://doi.org/10.1016/j.jcin.2019.05.017
Rymer, Jennifer A., Qun Xiang, Alice Wang, David J. Cohen, Nimesh D. Desai, Ajay J. Kirtane, G Chad Hughes, J Kevin Harrison, Andrzej S. Kosinski, and Sreekanth Vemulapalli. “Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement.JACC Cardiovasc Interv 12, no. 18 (September 23, 2019): 1768–77. https://doi.org/10.1016/j.jcin.2019.05.017.
Rymer JA, Xiang Q, Wang A, Cohen DJ, Desai ND, Kirtane AJ, et al. Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019 Sep 23;12(18):1768–77.
Rymer, Jennifer A., et al. “Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement.JACC Cardiovasc Interv, vol. 12, no. 18, Sept. 2019, pp. 1768–77. Pubmed, doi:10.1016/j.jcin.2019.05.017.
Rymer JA, Xiang Q, Wang A, Cohen DJ, Desai ND, Kirtane AJ, Hughes GC, Harrison JK, Kosinski AS, Vemulapalli S. Factors Associated With and Outcomes of Aborted Procedures During Elective Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv. 2019 Sep 23;12(18):1768–1777.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

September 23, 2019

Volume

12

Issue

18

Start / End Page

1768 / 1777

Location

United States

Related Subject Headings

  • United States
  • Treatment Failure
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Risk Factors
  • Risk Assessment
  • Retrospective Studies
  • Registries
  • Postoperative Complications
  • Peripheral Arterial Disease