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Dr Mesnier was supported by a research grant from Federation Francaise de Cardiologie. Dr Belahnech was supported by a research grant from Aula Vall d 'Hebron. Dr Rodes-Cabau holds the Research Chair Fondat ion Famille Jacques Lariviere for the Development of Structural Heart Disease Interventions; and has received institutional research grants and consultant/speaker fees from Edwards Life-sciences and Medtronic. Dr Ternacle has served as a consultant for Abbott. Dr Modine has served as a consultant for Abbott, Edwards Lifesciences, and Medtronic. Dr Nombela-Franco has served as a proctor for Abbott and Edwards Lifesciences. Dr Reguiero has served as a proctor for Abbott. Dr Himbert has served as a proctor for Abbott and Edwards Lifesciences. Dr Asmarats has received speaker fees from Edwards Lifesciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Cardiac Death After Transcatheter Aortic Valve Replacement With Contemporary Devices

Publicated to:Jacc-Cardiovascular Interventions. 16 (18): 2277-2290 - 2023-09-25 16(18), DOI: 10.1016/j.jcin.2023.07.015

Authors: Mesnier, Jules; Ternacle, Julien; Cheema, Asim N; Campelo-Parada, Francisco; Urena, Marina; Veiga-Fernandez, Gabriela; Nombela-Franco, Luis; Asmarats, Lluis; del Trigo, Maria; Serra, Vicenc; Bonnet, Guillaume; Jonveaux, Melchior; Rezaei, Effat; Matta, Anthony; Himbert, Dominique; Hernandez, Jose Maria de la Torre; Tirado-Conte, Gabriela; Fernandez-Nofrerias, Eduard; Vidal, Pablo; Alfonso, Fernando; Gutierrez-Alonso, Lola; Oteo, Juan Francisco; Belahnech, Yassin; Mohammadi, Siamak; Philippon, Francois; Modine, Thomas; Rodes-Cabau, Josep

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Abstract

BACKGROUND The burden of cardiac death after transcatheter aortic valve replacement (TAVR), particularly from advanced heart failure (HF) and sudden cardiac death (SCD), remains largely unknown. OBJECTIVES This study sought to evaluate the incidence and predictors of SCD and HF-related death in TAVR recipients treated with newer-generation devices.METHODS This study included a total of 5,421 consecutive patients who underwent TAVR with newer-generation devices using balloon (75.7%) or self-expandable (24.3%) valves.RESULTS After a median follow-up of 2 (IQR: 1-3) years, 976 (18.0%) patients had died, 50.8% from cardiovascular causes. Advanced HF and SCD accounted for 11.6% and 7.5% of deaths, respectively. Independent predictors of HF-related death were atrial fibrillation (HR: 2.17; 95% CI: 1.47-3.22; P < 0.001), prior pacemaker (HR: 1.79; 95% CI: 1.10-2.92; P = 0.01), reduced left ventricular ejection fraction (HR: 1.08 per 5% decrease; 95% CI: 1.01-1.14; P = 0.02), transthoracic approach (HR: 2.50; 95% CI: 1.37-4.55; P = 0.003), and new-onset persistent left bundle branch block (HR: 1.85; 95% CI: 1.14-3.02; P = 0.01). Two baseline characteristics (diabetes, HR: 1.81; 95% CI: 1.13-2.89; P = 0.01; and chronic kidney disease, HR: 1.72; 95% CI: 1.02-2.90; P = 0.04) and 3 procedural findings (valve in valve, HR: 2.17; 95% CI: 1.01-4.64; P = 0.04; transarterial nontransfemoral approach, HR: 2.23; 95% CI: 1.23-4.48; P = 0.01; and periprocedural ventricular arrhythmia, HR: 7.19; 95% CI: 2.61-19.76; P < 0.001) were associated with an increased risk of SCD after TAVR.CONCLUSIONS Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice. Potentially treatable factors leading to increased risk of HF deaths and SCD were identified, such as arrhythmia/ dyssynchrony factors for HF and valve-in-valve TAVR or periprocedural ventricular arrhythmias for SCD. (J Am Coll Cardiol Intv 2023;16:2277-2290) (c) 2023 by the American College of Cardiology Foundation.

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