Outcomes of Adults with Severe Aortic Stenosis Undergoing Urgent or Emergent vs. Elective Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System

Justin J Slade; Andrew P Ambrosy; Thomas K Leong; Sue Hee Sung; Elisha A Garcia; Ivy A Ku; Matthew D Solomon; Edward J McNulty; Andrew N Rassi; David C Lange; Femi Philip; Alan S Go; Jacob M Mishell

doi:10.1016/j.shj.2023.100166

Outcomes of Adults with Severe Aortic Stenosis Undergoing Urgent or Emergent vs. Elective Transcatheter Aortic Valve Replacement Within an Integrated Health Care Delivery System

Struct Heart. 2023 Mar 21;7(4):100166. doi: 10.1016/j.shj.2023.100166. eCollection 2023 Jul.

Authors

Justin J Slade^{1

2}, Andrew P Ambrosy^{1

2}, Thomas K Leong², Sue Hee Sung², Elisha A Garcia², Ivy A Ku¹, Matthew D Solomon², Edward J McNulty¹, Andrew N Rassi¹, David C Lange³, Femi Philip⁴, Alan S Go^{2

5

6

7}, Jacob M Mishell¹

Affiliations

¹ Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, California, USA.
² Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.
³ Department of Cardiology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, California, USA.
⁴ Department of Cardiology, Kaiser Permanente Sacramento Medical Center, Sacramento, California, USA.
⁵ Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA.
⁶ Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, California, USA.
⁷ Department of Medicine, Stanford University, Palo Alto, California, USA.

Abstract

Background: Transcatheter aortic valve replacement (TAVR) may be used to urgently or emergently treat severe aortic stenosis, but outcomes for this high-risk population have not been well-characterized. We sought to describe the incidence, clinical characteristics, and outcomes of patients undergoing urgent or emergent vs. elective TAVR.

Methods: We identified all adults who received TAVR for primary aortic stenosis between 2013 and 2019 within an integrated health care delivery system in Northern California. Elective or urgent/emergent procedure status was based on standard Society of Thoracic Surgeons definitions. Data were obtained from electronic health records, the Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy Registry, and state/national reporting databases. Logistic regression and Cox proportional hazard models were performed.

Results: Among 1564 eligible adults that underwent TAVR, 81 (5.2%) were classified as urgent/emergent. These patients were more likely to have heart failure (63.0% vs. 47.4%), reduced left ventricular ejection fraction (21.0% vs. 11.8%), or a prior aortic valve balloon valvuloplasty (13.6% vs. 5.0%) and experienced higher unadjusted rates of 30-day and 1-year morbidity and mortality. Urgent/emergent TAVR status was independently associated with non-improved quality of life at 30-days (hazard ratio, 4.87; p < 0.01) and acute kidney injury within 1-year post-TAVR (hazard ratio, 2.11; p = 0.01). There was not a significant difference in adjusted 1-year mortality with urgent/emergent TAVR.

Conclusions: Urgent/emergent TAVR status was uncommon and associated with high-risk clinical features and higher unadjusted rates of short- and long-term morbidity and mortality. Procedure status may be useful to identify patients less likely to experience significant short term improvement in health-related quality of life post-TAVR.

Keywords: Aortic stenosis; Quality-of-life; TAVR outcomes; Urgent/emergent.