TY - JOUR
T1 - One-Year Outcomes for Patients Undergoing Transcatheter Aortic Valve Replacement
T2 - The Gulf TAVR Registry
AU - Alasnag, Mirvat
AU - AlMerri, Khaled
AU - Almoghairi, Abdulrahman
AU - Alenezi, Abdullah
AU - Bardooli, Fawaz
AU - Al-Sheikh, Shereen
AU - Alanazi, Nouf
AU - AlHarbi, Waleed
AU - Al Lawati, Hatim
AU - Al Faraidy, Khalid
AU - AlShehri, Mohammed
AU - Thabane, Michael
AU - Thabane, Lehana
AU - Al-Shaibi, Khaled
N1 - Publisher Copyright:
© 2022 The Authors
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: The use of transcatheter aortic valve replacement (TAVR) is steadily increasing with TAVR procedures offered to patients across the entire spectrum of surgical risks. The Gulf TAVR registry captures the demographics of patients undergoing TAVR in the Gulf region, comorbidities that drive outcomes, procedural success, complications, and one-year outcomes of death or rehospitalization. Methods: This is a retrospective cohort study for adult patients aged at least 18 years undergoing TAVR at eight centers in the Gulf region. The primary outcome was a composite of death or re-hospitalization at one-year. Secondary outcomes included the individual components of the composite, stroke, and myocardial infarction (MI). We used multivariable Cox regression to determine factors associated with the composite endpoint. Results: A total of 795 patients (56% male) were included in the final analysis with a mean age of 74.6 (standard deviation (SD) 8.9) years, Society of Thoracic Surgeons Score (STS) Score 4.9 (4.2), ejection fraction of 53% (12.7%). Transfemoral approach was employed in over 95% (762/795). The primary outcomes rate was 12.8% (95% confidence interval [CI]: 10.6–15.4); secondary endpoints were death 5.4% (95% CI 4.0–7.2); stroke 0.8% (95% CI 0.3, 1.7), MI 0.8% (95% CI 0.4–1.9), rehospitalization: 9.3% (95% CI 7.5–11.5) of whom 71.6% were related to cardiovascular causes. 77% of the cardiovascular admissions were attributable to heart failure or the need for pacemaker implantation. Stage IV or V chronic kidney disease was significantly associated with the primary composite endpoint (Hazard Ratio: 2.49, [95% CI: 1.31, 4.73], p = 0.005). Although not significant, paravalvular leak and severe left ventricular dysfunction showed a 2-fold and 3-fold increased risk for the composite endpoint, respectively. Conclusions: The Gulf TAVR registry is the first of its kind in the region. It profiles an elderly population with a high procedural success rate and a low rate of complications. One-year outcomes were primarily driven by repeat hospitalization for heart failure and pacemaker implantation indicating a need to optimize heart failure management and improve algorithms for the detection of conduction abnormalities.
AB - Background: The use of transcatheter aortic valve replacement (TAVR) is steadily increasing with TAVR procedures offered to patients across the entire spectrum of surgical risks. The Gulf TAVR registry captures the demographics of patients undergoing TAVR in the Gulf region, comorbidities that drive outcomes, procedural success, complications, and one-year outcomes of death or rehospitalization. Methods: This is a retrospective cohort study for adult patients aged at least 18 years undergoing TAVR at eight centers in the Gulf region. The primary outcome was a composite of death or re-hospitalization at one-year. Secondary outcomes included the individual components of the composite, stroke, and myocardial infarction (MI). We used multivariable Cox regression to determine factors associated with the composite endpoint. Results: A total of 795 patients (56% male) were included in the final analysis with a mean age of 74.6 (standard deviation (SD) 8.9) years, Society of Thoracic Surgeons Score (STS) Score 4.9 (4.2), ejection fraction of 53% (12.7%). Transfemoral approach was employed in over 95% (762/795). The primary outcomes rate was 12.8% (95% confidence interval [CI]: 10.6–15.4); secondary endpoints were death 5.4% (95% CI 4.0–7.2); stroke 0.8% (95% CI 0.3, 1.7), MI 0.8% (95% CI 0.4–1.9), rehospitalization: 9.3% (95% CI 7.5–11.5) of whom 71.6% were related to cardiovascular causes. 77% of the cardiovascular admissions were attributable to heart failure or the need for pacemaker implantation. Stage IV or V chronic kidney disease was significantly associated with the primary composite endpoint (Hazard Ratio: 2.49, [95% CI: 1.31, 4.73], p = 0.005). Although not significant, paravalvular leak and severe left ventricular dysfunction showed a 2-fold and 3-fold increased risk for the composite endpoint, respectively. Conclusions: The Gulf TAVR registry is the first of its kind in the region. It profiles an elderly population with a high procedural success rate and a low rate of complications. One-year outcomes were primarily driven by repeat hospitalization for heart failure and pacemaker implantation indicating a need to optimize heart failure management and improve algorithms for the detection of conduction abnormalities.
KW - Aortic stenosis
KW - Cardiovascular outcomes
KW - STS score
KW - TAVR
KW - Humans
KW - Risk Factors
KW - Male
KW - Stroke/etiology
KW - Transcatheter Aortic Valve Replacement/adverse effects
KW - Treatment Outcome
KW - Aortic Valve Stenosis/diagnostic imaging
KW - Adolescent
KW - Heart Failure
KW - Adult
KW - Female
KW - Registries
KW - Aged
KW - Retrospective Studies
KW - Aortic Valve/diagnostic imaging
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UR - http://www.scopus.com/inward/citedby.url?scp=85122615643&partnerID=8YFLogxK
U2 - 10.1016/j.carrev.2021.12.024
DO - 10.1016/j.carrev.2021.12.024
M3 - Article
C2 - 35033460
AN - SCOPUS:85122615643
SN - 1553-8389
VL - 41
SP - 19
EP - 26
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -