Outcomes Following Urgent/Emergent Transcatheter Aortic Valve Replacement
| Autor: | Ignacio Inglessis, Vinod H. Thourani, Sammy Elmariah, Andrew M. Goldsweig, Sahil Khera, Herbert D. Aronow, Paul C. Gordon, J. Dawn Abbott, Igor F. Palacios, Dadi Dai, Sreekanth Vemulapalli, Stephan Heo, Barry L. Sharaf, Dhaval Kolte |
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| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry Cardiogenic shock medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease 03 medical and health sciences Stenosis 0302 clinical medicine Valve replacement Interquartile range Emergency medicine medicine 030212 general & internal medicine Myocardial infarction Cardiology and Cardiovascular Medicine Adverse effect business Stroke Dialysis |
| Zdroj: | JACC: Cardiovascular Interventions. 11:1175-1185 |
| ISSN: | 1936-8798 |
| DOI: | 10.1016/j.jcin.2018.03.002 |
| Popis: | Objectives The authors sought to examine outcomes and identify independent predictors of mortality among patients undergoing urgent/emergent transcatheter aortic valve replacement (TAVR). Background Data on urgent/emergent TAVR as a rescue therapy for decompensated severe aortic stenosis (AS) are limited. Methods The Society of Thoracic Surgeons and the American College of Cardiology Transcatheter Valve Therapy (STS/ACC TVT) Registry linked with Centers for Medicare & Medicaid Services claims was used to identify patients who underwent urgent/emergent versus elective TAVR between November 2011 and June 2016. Outcomes assessed were device success rate, in-hospital major adverse events, and 30-day and 1-year mortality. Independent predictors of mortality after urgent/emergent TAVR were examined. Results Of 40,042 patients who underwent TAVR, 3,952 (9.9%) were urgent/emergent (median STS PROM score 11.8 [interquartile range: 7.6 to 17.9]). Device success rate was statistically lower, but not clinically different after urgent/emergent versus elective TAVR (92.6% vs. 93.7%; p = 0.007). Rates of major and/or life-threatening bleeding, major vascular complications, myocardial infarction, stroke, new permanent pacemaker placement, conversion to SAVR, and paravalvular regurgitation were similar between the 2 groups. Compared with elective TAVR, patients undergoing urgent/emergent TAVR had higher rates of acute kidney injury and/or new dialysis (8.2% vs. 4.2%; p Conclusions Urgent/emergent TAVR is feasible with acceptable outcomes and may be a reasonable option in a selected group of patients with severe AS. |
| Databáze: | OpenAIRE |
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