Predictors of 1-year mortality after transcatheter aortic valve replacement

Objective: To identify variables predictive of increased mortality within 1 year of transcatheter aortic valve replacement (TAVR).

Methods: We retrospectively reviewed the records of 723 consecutive patients who received TAVR from November 2008 through April 2016. Patient and procedure-related characteristics were analyzed with logistic regression for an association with death within 1 year of TAVR.

Results: Patient mean age was 81 ± 9 years, male sex was present in 428 patients (59%), and STS predicted risk of mortality was 9.2 ± 6.2%. There were 107 deaths (15%) within 1 year of operation. Multivariable analysis identified increased risk of death with severe chronic lung disease (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.23-3.29; P = 0.006), severe tricuspid valve regurgitation (OR 2.35; 95%CI 1.17-4.30; P = 0.017), vascular injury (OR 2.23; 95%CI 1.15-4.30; P = 0.017), and new-onset dialysis (OR 8.49; 95%CI 3.00-24.03; P < 0.001) (Area under the curve 0.687). When stratified by arterial access, there was increased risk of death following severe tricuspid valve regurgitation, vascular injury, or new-onset dialysis for transfemoral access and severe chronic lung disease or new-onset dialysis for alternative access.

Conclusion: Patient characteristics and procedure-related complications are both significantly associated with increased risk of death within 1 year of TAVR. Patients with the baseline findings of severe chronic lung disease or severe tricuspid valve regurgitation may not experience mortality benefit from TAVR, and they should be assessed and counselled accordingly. Avoiding procedure-related complications is paramount to a good outcome. The findings have important implications for health care delivery services.