Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02180-w
Clinical characteristics and outcomes of patients undergoing urgent versus elective transcatheter aortic valve implantation
H. Seoudy1, S. Wundram1, J. Frank1, P. Bramlage2, L. Ritter1, M. Farahmandi1, R. Rangel1, M. Salem1, T. Pühler3, G. Lutter3, M. Lutz1, J. Dümmler4, N. Frey5, M. Saad1, D. Frank1
1Klinik für Innere Medizin III, Schwerpunkt Kardiologie und Angiologie, Universitätsklinikum Schleswig-Holstein, Kiel; 2Dr. Bramlage & Dr. Hankowitz Partnerschaft, Institut für Pharmakologie und präventive Medizin, Mahlow; 3Klinik für Herz- und Gefäßchirurgie, Universitätsklinikum Schleswig-Holstein, Kiel; 4Universitätsklinikum Schleswig-Holstein, Kiel; 5Klinik für Innere Med. III, Kardiologie, Angiologie u. Pneumologie, Universitätsklinikum Heidelberg, Heidelberg;

Background: Transcatheter aortic valve implantation (TAVI) has emerged as an essential treatment option for patients with symptomatic aortic stenosis across all risk groups. While the majority of TAVI cases are performed as elective procedures, a substantial number of patients are in need of urgent TAVI. The objective of this study was to compare the clinical characteristics and outcomes of urgent versus elective TAVI patients.

Methods: This single-center study included 512 patients undergoing transfemoral TAVI between 10/2018 and 12/2020; 134 patients (26.2%) were treated with urgent TAVI, while 378 patients (73.8%) were admitted for an elective procedure. Clinical characteristics and mortality rates at 30 days and 1 year were analysed comparing both groups.

Results: The median age of the study population was 82.0 years with no significant difference between both groups (p=0.067). Patients undergoing urgent TAVI had higher rates of NYHA class IV on admission (p<0.001), frailty syndrome (p<0.001), atrial fibrillation (p=0.030), impaired kidney function (p<0.001) as well as higher levels of high-sensitivity troponin T (p<0.001) and NT-proBNP (p<0.001). While new pacemaker implantation was more frequently observed in urgently treated patients (p=0.029), there was no significant difference regarding rates of periprocedural stroke, life-threatening bleeding complications, myocardial infarction, conversion to open surgery or advanced stages of acute kidney injury (AKIN stage 3/4). All-cause mortality at 30 days was 3.7% for the urgent and 1.1% for the elective patient group (p=0.030). At 1 year, all-cause mortality among urgent TAVI patients was disproportionately higher than in elective patients (18.7% versus 5.0%, p<0.001).

Conclusion: A significant number of patients underwent urgent TAVI. While urgently treated patients had acceptable periprocedural outcomes, mortality rates at 1 year were significantly higher compared to elective patients. Improvements in follow-up strategies and optimized treatment of patients after urgent TAVI are needed.
https://dgk.org/kongress_programme/jt2023/aP2079.html