Background:

Aortic stenosis (AS) is one of the most common heart valve diseases in the elderly and due to demographic changes and the ageing society, the prevalence of the disease will further increase in the next decades, representing a tremendous socio-economic and health care burden. Among symptomatic patients with medically treated moderate-to-severe AS, mortality from the onset of symptoms is approximately 25% at 1 year and 50% at 2 years. To date, the only treatment of severe AS is replacement of the diseased aortic valve either via surgery or transcatheter aortic valve replacement (TAVR). In 2019, around 21.000 patients with severe symptomatic AS were treated with TAVR in Germany. However, the waiting lists for such a procedure in Germany are long and the mortality rates in the time between determining the indication for TAVR and the procedure itself are unknow.

Objectives:

The purpose of this retrospective study was to investigate the mortality rate in patients with severe symptomatic aortic valve stenosis scheduled for transcatheter aortic valve replacement awaiting the procedure.

Methods:

Between January 2019 and June 2022, 1568 patients with severe symptomatic aortic valve stenosis and increased operative risk were evaluated and finally scheduled for transcatheter aortic valve replacement at the Heart Center Bonn after interdisciplinary discussion within the local, institutional Heart Team. Within this cohort, we retrospectively assessed the mortality rate in the time between determining the indication for TAVR in the Heart Team and the procedure itself.  

Results:

Between January 2019 and June 2022, 1568 patients were evaluated and scheduled for TAVR at the Heart Center Bonn. The mean age of the overall study population was 80.7 years (±6.4). Out of 1568 patients, 63 (4%) died during the waiting period (Figure 1). The mean age of the deceased patients was 79.9 years (±7.8) and 45 patients (71,4%) were of male gender. Concerning baseline characteristics, 39 patients (61.9%) had concomitant coronary artery disease (CAD), 20 patients (31.7%) had chronic obstructive pulmonary disease (COPD) and 39 (61.9%) had chronic kidney disease, reflecting a high EuroSCORE II of 11.05 (±9.9) and representing a high-risk cohort. The echocardiographic parameters were as follows: the mean EF was 44% (±13.4), the mean aortic valve area (AVA) was 0.75 cm² (±0.21) and the mean peak flow velocity was (Vmax) was 4.01m/s (±0.7).In the group of the non-survivors, the rate of cardiovascular death was 44.4%, whereas 19.1% died due to non-cardiovascular causes. For 36.8% of the patients, the reason of death was unknown. The mean time from determining the indication for TAVR to death was 32 days, the mean time to TAVR procedure in the overall cohort was 49 days.

Conclusion:

The mortality rate of patients with severe symptomatic AS and the indication for treatment (TAVR) is 4% during a mean waiting period of 32 days. Our study results indicate that a shorter waiting interval from determining the indication for TAVR and the actual procedure is needed in selected high-risk patients. Our results are hypothesis-generating. Patients being at high mortality risk during the waiting period for TAVR have to be characterized better, so that selected patients can be treated earlier.