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Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis.

Publication ,  Journal Article
Anwaruddin, S; Desai, ND; Vemulapalli, S; Marquis-Gravel, G; Li, Z; Kosinski, A; Reardon, MJ
Published in: JACC Cardiovasc Interv
February 8, 2021

OBJECTIVES: This study sought to better understand out-of-hospital 30-day mortality following transfemoral transcatheter aortic valve replacement (TAVR) and identify factors associated with poor outcomes. BACKGROUND: Despite improvements in outcomes with TAVR for severe aortic stenosis, out-of-hospital 30-day mortality has not been evaluated. METHODS: This study examined patients in the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) 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 pre-specified factors and endpoints. RESULTS: A total of 106,749 patients 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%) patients 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 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 as being independently associated with the primary endpoint. 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. CONCLUSIONS: We identified 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 following TAVR.

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Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 8, 2021

Volume

14

Issue

3

Start / End Page

261 / 274

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke Volume
  • Risk Factors
  • Registries
  • Humans
  • Hospitals
  • Cardiovascular System & Hematology
 

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Anwaruddin, S., Desai, N. D., Vemulapalli, S., Marquis-Gravel, G., Li, Z., Kosinski, A., & Reardon, M. J. (2021). Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis. JACC Cardiovasc Interv, 14(3), 261–274. https://doi.org/10.1016/j.jcin.2020.10.027
Anwaruddin, Saif, Nimesh D. Desai, Sreekanth Vemulapalli, Guillaume Marquis-Gravel, Zhuokai Li, Andrzej Kosinski, and Michael J. Reardon. “Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis.JACC Cardiovasc Interv 14, no. 3 (February 8, 2021): 261–74. https://doi.org/10.1016/j.jcin.2020.10.027.
Anwaruddin S, Desai ND, Vemulapalli S, Marquis-Gravel G, Li Z, Kosinski A, et al. Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis. JACC Cardiovasc Interv. 2021 Feb 8;14(3):261–74.
Anwaruddin, Saif, et al. “Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis.JACC Cardiovasc Interv, vol. 14, no. 3, Feb. 2021, pp. 261–74. Pubmed, doi:10.1016/j.jcin.2020.10.027.
Anwaruddin S, Desai ND, Vemulapalli S, Marquis-Gravel G, Li Z, Kosinski A, Reardon MJ. Evaluating Out-of-Hospital 30-Day Mortality After Transfemoral Transcatheter Aortic Valve Replacement: An STS/ACC TVT Analysis. JACC Cardiovasc Interv. 2021 Feb 8;14(3):261–274.
Journal cover image

Published In

JACC Cardiovasc Interv

DOI

EISSN

1876-7605

Publication Date

February 8, 2021

Volume

14

Issue

3

Start / End Page

261 / 274

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • United States
  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Stroke Volume
  • Risk Factors
  • Registries
  • Humans
  • Hospitals
  • Cardiovascular System & Hematology