Valvular & structural heart diseaseCohort study
Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices
- Cohort study
- consecutive patients
Authors' conclusion
Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice.
Study context
- Population
- Consecutive patients undergoing transcatheter aortic valve replacement (TAVR) with newer-generation devices (balloon-expandable 75.7%, self-expandable 24.3%)
- Participants
- 5,421 patients
- Outcome
- Incidence and predictors of SCD and HF-related death
Main finding
As reported in the abstract
Deaths and causes of death · median follow-up 2 (IQR: 1-3) years
All-cause death
976 (18.0%)
CV causes, share of deaths
50.8%
Advanced heart failure (HF), share of deaths
11.6%
Sudden cardiac death (SCD), share of deaths
7.5%
Observational data: associations, not effects.
Further findings
Independent predictors of HF-related death
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| atrial fibrillation | 2.17 (1.47–3.22) | P < 0.001 | |
| prior pacemaker | 1.79 (1.10–2.92) | P = 0.01 | |
| transthoracic approach | 2.50 (1.37–4.55) | P = 0.003 | |
| new-onset persistent left bundle branch block | 1.85 (1.14–3.02) | P = 0.01 | |
| 0.20.5125Hazard ratio (log scale) |
| Outcome | HR (per 5% decrease) (95% CI) | P value | |
|---|---|---|---|
| Independent predictors of HF-related death — reduced left ventricular ejection fraction | 1.08 (1.01–1.14) | P = 0.02 | |
| 0.512Hazard ratio (log scale) |
Factors associated with increased risk of SCD
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| diabetes · baseline characteristic | 1.81 (1.13–2.89) | P = 0.01 | |
| chronic kidney disease · baseline characteristic | 1.72 (1.02–2.90) | P = 0.04 | |
| valve in valve · procedural finding | 2.17 (1.01–4.64) | P = 0.04 | |
| transarterial nontransfemoral approach · procedural finding | 2.23 (1.23–4.48) | P = 0.01 | |
| periprocedural ventricular arrhythmia · procedural finding | 7.19 (2.61–19.76) | P < 0.001 | |
| 0.050.21520Hazard ratio (log scale) |
Original publication
Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices. JACC Cardiovasc Interv. Published 25 September 2023. doi:10.1016/j.jcin.2023.07.015
Summarised from the published abstract; every number is checked against it